Thread: 11+ States sue .gov over Healthcare Reform Bill

Originally Posted by Harry

Corky; you are correct about the amounts. But you are NOT correct about it being a "penalty". . . .

Apparently, the Fox News/teabagger crowd has a basic level of reading comprehension; something it seems you've yet to master. Since you're either too dense or too lazy to find it, here are the pertinent provisions in plain english; which provisions clearly impose a penalty for failure to procure minimum essential coverage:

‘‘SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSEN18
TIAL COVERAGE.
‘‘(a) REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.—An applicable individual shall for each month beginning after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month.

‘‘(3) PAYMENT OF PENALTY.—If an individual with respect to whom a penalty is imposed by this section for any month

‘‘(1) IN GENERAL.—The penalty determined under this subsection for any month with respect to any individual is an amount equal to 1⁄12 of the applicable dollar amount for the calendar year.

‘‘(3) APPLICABLE DOLLAR AMOUNT.—For purposes of paragraph (1)—
‘‘(A) IN GENERAL.—Except as provided in subparagraphs (B) and (C), the applicable dollar amount is $750.

‘‘(g) ADMINISTRATION AND PROCEDURE.—
‘‘(1) IN GENERAL.—The penalty provided by this
section shall be paid upon notice and demand by the
Secretary, and except as provided in paragraph (2),
shall be assessed and collected in the same manner as
an assessable penalty under subchapter B of chapter
68."


There is too much to paste here, but please try employing critical thinking skills and researching something yourself prior to regurgitating lies and half-truths fed to you by either political party.

To address your rebuttal specifically, the "penalty," as that term is used in the bill, is not a mere refusal to issue a refund. It is a true penalty. If you don't obtain minimum essential coverage, as defined elsewhere in the bill, you will owe Uncle Sam the amount imposed as a penalty--whether you are entitled to any credit or not. You will not go to jail, however, as the bill specifically waives criminal prosecution and/or penalties.

Disclaimer: I have not read the entire bill, but feel free to point me to the provision that you seem to be referring to.

Obama-Nate and Harry got game. Same person? lol...

OK, so we are clear now.

If you don't pay money to a private insurance company (or are otherwise covered by .gov or employer) then you will be fined by the government, but nonpayment will only result in garnishment, not imprisonment.

Still doesn't sit right with me. I don't think the SCOTUS would support that.

Harry,

Your failed attempt at semantics doesn't change the fact that individuals and companies will be out of pocket money because they didn't purchase insurance. You can wrap shit up in a pretty papered box. It's still shit when you open the package.

The use of the word "penalty" in the legislation is a bit of a clue wouldn't you say ?

If the individuals CANNOT pay for insurance then they qualify for aid.

If the individuals WILL NOT pay for insurance they get fined.

I'm down with that, especially since the Public Option was shot down by the same people who ironically are now whining now about propping up private business. (really?) Whether or not it passes a Right-wing activist SCOTUS remains to be seen. At least they haven't tried to overturn Roe v. Wade yet.

Anyone? Anyone?

[nomedia="http://www.youtube.com/watch?v=Nk_HPs34usU"]YouTube- Congressman John Dingell: "It takes a long time to ... control the people"[/nomedia]

Originally Posted by Obama Nate

‘‘(g) ADMINISTRATION AND PROCEDURE.—
‘‘(1) IN GENERAL.—The penalty provided by this
section shall be paid upon notice and demand by the
Secretary, and except as provided in paragraph (2),
shall be assessed and collected in the same manner as
an assessable penalty under subchapter B of chapter
68."


To address your rebuttal specifically, the "penalty," as that term is used in the bill, is not a mere refusal to issue a refund. It is a true penalty.
Disclaimer: I have not read the entire bill, but feel free to point me to the provision that you seem to be referring to.

subchapter B of chapter 68 is the part of the tax code dealing with withholding payment of tax returns.

example: you take a student loan with a private bank. you graduate from college but do not pay back the student loan. When you file your tax return, you are surprised to see that the $2,000 you where expecting back from Uncle Sam has been taken from your tax return and given to the private bank.

But they can't garnish your wages, they can't throw you in jail, they can't put a lien on your real property.

Again: the republican AG lawsuit will fall flat on it's face because the new Health Care Law uses enforcement mechanisms that are currently well accepted as being entirely within the realm of the Constitution.

Mitt Romney's take on the individual mandate in Massachusetts back in 2006:

Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian, - Mitt Romney

He seemed like one of the most viable Republican Presidential Candidates for 2012. Now that RomneyCare has passed for the entire nation, I'm not so sure.

Originally Posted by tommyvee

Personally I would have been very happy to have a public option, so that we were not forced to pay private insurers, but the Republican intransigence doomed the public option, for the moment.

In the unlikely event that the R's suit makes it to the Supreme Court, the consequence would be to strike down the universal coverage mandate, while preserving the pre-existing condition prohibition and prohibiting rescission. This would rapidly bankrupt the insurers, due to the "adverse selection problem" that Krugman writes about (rational consumers would then wait until they were sick to get insurance, of course). Anything that bankrupts the insurers will not last, so likely the mandated premiums would rapidly become mandated taxes to pay premiums, which is certainly constitutional.

So now it is the public option that would have saved insurance companies? This is nice spin blaming the Repubs for the eventual demise of insurance companies. Both sides are full of shit.

Look, my wife is an insurance broker. There is a lot you don't know about how shit works.

If individuals are allowed to pool, across state lines, with no exclusion for pre-existing conditions, that shit will get expensive fast. They are already seeing 35-50% increases for group plans under 100 lives- the shit pool that nobody wants. These are the companies that insurance companies don't want. The pay off is never worth it- one bad claim, and they are screwed. No claims, you are lucky with a 35% increase. These people will be in the public pool quicker than you can blink. It will drive costs of that pool sky high. The only option at that point will be a public option. No insurance company will be willing to lose the money. They are running a business.

What does a contractor do if he is too busy, or doesn't want your business? Does he not quote your job? Hell no! He quotes you at a redonkulous rate, and then gives you shitty service if you bite. Now what if there was a government option to have your home repairs done on the cheap? You might have to wait a while for service, the service might be a little worse, but all in all, it is acceptable for the low price. The rich are out of this equation- they get their home repairs done quickly at high rates.

That is how this thing will go down. The insurance companies will cater only to big companies, and the rich, and the rest of the people will be in the cesspool. When the cesspool rates go too high, the government will step in and "save the day" from the evil insurance companies, who were not willing to take losses to support "the people". Whammo- we will have a government option.

That is my take, and anyone else I talk to in the insurance field. Now, you may think that opinion is skewed because they work for insurance companies. You might be right. Surprisingly, doctors and nurses I have spoken with have the same take- basically.

LSP
Anyone?

Originally Posted by warthog

Look, my wife is an insurance broker. There is a lot you don't know about how shit works.

Look, my wife is a sculpter but that doesn't mean I know how to sculpt. Think before you post please.

Originally Posted by Adolf Allerbush

Look, my wife is a sculpter but that doesn't mean I know how to sculpt. Think before you post please.

Were you going to counter any of his arguments or just be butthurt?

Originally Posted by Summit

Were you going to counter any of his arguments or just be butthurt?

Just be butthurt. But since you asked...

Have insurance companies been able to pool these uninsured workers together across statelines before? If so, then maybe Warthog has a point. Otherwise I think he's missing the point of pooling these people together. I don't think we're talking about pooling together in 100 person increments.

Originally Posted by warthog

So now it is the public option that would have saved insurance companies? This is nice spin blaming the Repubs for the eventual demise of insurance companies. Both sides are full of shit.

Look, my wife is an insurance broker. There is a lot you don't know about how shit works.

If individuals are allowed to pool, across state lines, with no exclusion for pre-existing conditions, that shit will get expensive fast. They are already seeing 35-50% increases for group plans under 100 lives- the shit pool that nobody wants. These are the companies that insurance companies don't want. The pay off is never worth it- one bad claim, and they are screwed. No claims, you are lucky with a 35% increase. These people will be in the public pool quicker than you can blink. It will drive costs of that pool sky high. The only option at that point will be a public option. No insurance company will be willing to lose the money. They are running a business.

What does a contractor do if he is too busy, or doesn't want your business? Does he not quote your job? Hell no! He quotes you at a redonkulous rate, and then gives you shitty service if you bite. Now what if there was a government option to have your home repairs done on the cheap? You might have to wait a while for service, the service might be a little worse, but all in all, it is acceptable for the low price. The rich are out of this equation- they get their home repairs done quickly at high rates.

That is how this thing will go down. The insurance companies will cater only to big companies, and the rich, and the rest of the people will be in the cesspool. When the cesspool rates go too high, the government will step in and "save the day" from the evil insurance companies, who were not willing to take losses to support "the people". Whammo- we will have a government option.

That is my take, and anyone else I talk to in the insurance field. Now, you may think that opinion is skewed because they work for insurance companies. You might be right. Surprisingly, doctors and nurses I have spoken with have the same take- basically.

I think this post makes an important point... unfortunately maybe not the one that was intended.

I'd argue it's pretty clear the bigger part of the "problem" is with health INSURANCE these days, versus health CARE itself... after acknowledging that, we can all go back to squabbling about what the fix for it is.

Maybe health care is just an area where using private "insurance" to organize collection of funds, and distribution of payouts, just isn't practical. Seems the other 19 of the 20 largest economies in the world have that more sorted out than we do?

Trying to think of an analogy... imagine we had to buy "insurance" to pay for upkeep of the public road ways. Everyone pays in to private companies based on some formula, the companies keep some portion, then are suppose to pay out to contractors to build bridges and resurface roads and etc based on where their insureds drive. How big of a shitshow would that be?!?

Some would claim "I don't need to drive to Minnesota, fuck if my insurance companies money will pay for an expensive bridge over the Mississippi"... just like "I don't need to have an MRI now, fuck if my insurance companies money will pay to have a local/regional hospital have an MRI machine". Unfortunately, "we" need the bridges, "we" need the MRI machines... at some point it makes sense to have these mutual needs, especially when considered a basic human right by all of the civilized world (which obviously excludes Republicans these days) paid for by state collection of funds and prioritizing of distribution.

It may not be the perfect analogy, but explains that not every need can properly or efficiently be addressed by a private marketplace.

Originally Posted by warthog

So now it is the public option that would have saved insurance companies? This is nice spin blaming the Repubs for the eventual demise of insurance companies. Both sides are full of shit.

Look, my wife is an insurance broker. There is a lot you don't know about how shit works.

If individuals are allowed to pool, across state lines, with no exclusion for pre-existing conditions, that shit will get expensive fast. They are already seeing 35-50% increases for group plans under 100 lives- the shit pool that nobody wants. These are the companies that insurance companies don't want. The pay off is never worth it- one bad claim, and they are screwed. No claims, you are lucky with a 35% increase. These people will be in the public pool quicker than you can blink. It will drive costs of that pool sky high. The only option at that point will be a public option. No insurance company will be willing to lose the money. They are running a business.

What does a contractor do if he is too busy, or doesn't want your business? Does he not quote your job? Hell no! He quotes you at a redonkulous rate, and then gives you shitty service if you bite. Now what if there was a government option to have your home repairs done on the cheap? You might have to wait a while for service, the service might be a little worse, but all in all, it is acceptable for the low price. The rich are out of this equation- they get their home repairs done quickly at high rates.

That is how this thing will go down. The insurance companies will cater only to big companies, and the rich, and the rest of the people will be in the cesspool. When the cesspool rates go too high, the government will step in and "save the day" from the evil insurance companies, who were not willing to take losses to support "the people". Whammo- we will have a government option.

That is my take, and anyone else I talk to in the insurance field. Now, you may think that opinion is skewed because they work for insurance companies. You might be right. Surprisingly, doctors and nurses I have spoken with have the same take- basically.

So why did the stock price of insurance companies just go up after HCR?
The Tea Party party line is that markets are perfect and know all (unlike the bumbling government) so the stock market must be correct in estimating ins companies future prospects.

The simple, reasonable answer is that HCR will not be that bad for insurance companies, because they will all be competing in the same regulated environment and normal market equilibrium prices will result in the companies making reasonable profits. If they are profiteering, then they can expect a public option to keep them honest.

My wife is not an insurance broker but I have decades of experience as an insurance consumer and I can verify every time that my family has a medical bill they waste my time and theirs, denying payment, sending intentionally incomprehensible paperwork, playing phone tag and using arcane automated phone systems with no human access, etc. The doctors and nurses that I know employ many people just to handle the ridiculous flood of insurance company paperwork, and most of them support HCR.
Common sense says this absurdly complicated system is less efficient than simply paying medical professionals to keep people healthy. And indeed, countries with single-payer and without all the arcane insurance company bureaucracy do deliver more care for less money.

Originally Posted by Summit

OK, so we are clear now.

If you don't pay money to a private insurance company (or are otherwise covered by .gov or employer) then you will be fined by the government, but nonpayment will only result in garnishment, not imprisonment.

Still doesn't sit right with me. I don't think the SCOTUS would support that.

Then we can't get rid of pre-existing conditions exclusions and force guaranteed issue. Period. It has to be there for this all to work.

So are we gonna see big increases in premiums because of the pre existing exclusion being struck down ??

Originally Posted by tommyvee

So why did the stock price of insurance companies just go up after HCR?
The Tea Party party line is that markets are perfect and know all (unlike the bumbling government) so the stock market must be correct in estimating ins companies future prospects.

The simple, reasonable answer is that HCR will not be that bad for insurance companies, because they will all be competing in the same regulated environment and normal market equilibrium prices will result in the companies making reasonable profits. If they are profiteering, then they can expect a public option to keep them honest.

My wife is not an insurance broker but I have decades of experience as an insurance consumer and I can verify every time that my family has a medical bill they waste my time and theirs, denying payment, sending intentionally incomprehensible paperwork, playing phone tag and using arcane automated phone systems with no human access, etc. The doctors and nurses that I know employ many people just to handle the ridiculous flood of insurance company paperwork, and most of them support HCR.
Common sense says this absurdly complicated system is less efficient than simply paying medical professionals to keep people healthy. And indeed, countries with single-payer and without all the arcane insurance company bureaucracy do deliver more care for less money.

Corky, thanks for a common sense opinion, which I can value due to your experience in the field. I think a common sense analogy would be utilities, since that is formerly my area, insomuch as if there was no regulation of utilities, we'd all be paying whatever the utility stockholders decided the market could bear and whatever would keep them phat. Big Pharma has been killin us, literally and figuratively, to make the prime stockholders rich. Sure, they roll out arguments that sound convincing, but it's all about keeping the rich richer at the expense of the little (poor) people. With rate structures put in line with reasonable allowed profits, like the utilities that get to mae 13% a year, the insurance companies can stop paying for all those people denying claims and get on to the real issue, health care, without having to kill people for profits. The death panels have already been in effect for a long time. How this eludes some people touting that Palinesque phrase puzzles me.

Originally Posted by warthog

So now it is the public option that would have saved insurance companies? This is nice spin blaming the Repubs for the eventual demise of insurance companies. Both sides are full of shit.

Look, my wife is an insurance broker. There is a lot you don't know about how shit works.

If individuals are allowed to pool, across state lines, with no exclusion for pre-existing conditions, that shit will get expensive fast. They are already seeing 35-50% increases for group plans under 100 lives- the shit pool that nobody wants. These are the companies that insurance companies don't want. The pay off is never worth it- one bad claim, and they are screwed. No claims, you are lucky with a 35% increase. These people will be in the public pool quicker than you can blink. It will drive costs of that pool sky high. The only option at that point will be a public option. No insurance company will be willing to lose the money. They are running a business.

What does a contractor do if he is too busy, or doesn't want your business? Does he not quote your job? Hell no! He quotes you at a redonkulous rate, and then gives you shitty service if you bite. Now what if there was a government option to have your home repairs done on the cheap? You might have to wait a while for service, the service might be a little worse, but all in all, it is acceptable for the low price. The rich are out of this equation- they get their home repairs done quickly at high rates.

That is how this thing will go down. The insurance companies will cater only to big companies, and the rich, and the rest of the people will be in the cesspool. When the cesspool rates go too high, the government will step in and "save the day" from the evil insurance companies, who were not willing to take losses to support "the people". Whammo- we will have a government option.

That is my take, and anyone else I talk to in the insurance field. Now, you may think that opinion is skewed because they work for insurance companies. You might be right. Surprisingly, doctors and nurses I have spoken with have the same take- basically.

Good stuff warthog.

I don't think it'll be too bad for a few reasons.

- Most of the uninsured are young and healthy
- Providers will have vastly reduced costs from the uninsured and should have no problem getting reduced reimbursement from private insurers (or at least hold current reimbursement for a while)
- Getting people access to preventive and maintenance care will reduce costs from health crises

I wouldn't say the small group market is the shit pool anyway. Even the individual market isn't the 'shit pool'. Just when you get into very small businesses and especially individuals, you get hyper anti-selection where people choose to run without insurance until something happens and then they try to buy in. The individual market has dealt with this by having very low rates for young and healthy, excluding pre-existing conditions and denying coverage. The last two were necessary to keep the young and healthy on and not cause a spiral (as you alluded to).

In the very small group market is isn't too bad because the numbers that stay out until they need care are much smaller -- but it's guaranteed issue (at least where I've worked) so they can do it -- and they do. I've seen it plenty. They'll even risk getting denied by lying on their health questionaires just to get lower premium when the most they get is max rated (85% higher than the lowest rate).

What was my point? Oh yeah, the mandate and getting everybody covered and having all insurers on the same rules should mitigate the cost spirals.

Originally Posted by OSECS

So are we gonna see big increases in premiums because of the pre existing exclusion being struck down ??

money has to come from somewhere. YOU get to pay for those folks

^^^^^If that's true then the whole healthcare isn't gonna break us is a lie... wait a minute I get it now. It's not gonna break the gov't it's gonna break the people who can afford to pay for it for themselves and now others. Oh, I'm such a silly goose.

Originally Posted by Adolf Allerbush

Just be butthurt. But since you asked...

Have insurance companies been able to pool these uninsured workers together across statelines before? If so, then maybe Warthog has a point. Otherwise I think he's missing the point of pooling these people together. I don't think we're talking about pooling together in 100 person increments.

If we were talking about sculpting, I would bet you know more about it than I do. We talk about this all the time, she has real life insight from experience. How is this not thinking before I post?

They have never been able to sell health insurance across state lines. Most insurance people I now are all for it, because of the increased competition. It is better for their clients to get competitive rates. Where this breaks down is the pooling of individuals. Those small groups will likely get priced right into the pool. Hopefully not, but it is looking likely. No, these will be thousands of people, but the rates might be skewed by the people they "have" to take. What the fear is, is that only the C and D rated insurers will take on this risk. The A and B guys- the ones you want, will only stick to big corps. and the rich. It is a total possibility.

In home insurance, it goes like this. The cheap guys are horrible, and the A and B rated carriers are really pricey. Around here, home insurance costs as much as taxes do. The poor go with the shit carriers, and get screwed if they ever have a claim. The rich pay out there nose, but get great response. What would make this any different with healthcare?

Originally Posted by Corky

Good stuff warthog.

I don't think it'll be too bad for a few reasons.

- Most of the uninsured are young and healthy- I have never heard that claimed- hope you are right, but I think that is a rosey picture.
- Providers will have vastly reduced costs from the uninsured and should have no problem getting reduced reimbursement from private insurers (or at least hold current reimbursement for a while)-That might happen, but when the big guys get out of that business, and the crap carriers are the only thing left, I fear a revolt. The only thing that can cure that revolt will be a single payer option. I think that is the end goal here.
- Getting people access to preventive and maintenance care will reduce costs from health crises-Again, I see this as a rosey picture. In theory you are right, but I don't see Joe Blow forking out $30 or $40 for a checkup. There is a significant part of the population that uses the emergency room as their doctor. I don't think you will change that thinking any time soon.

I wouldn't say the small group market is the shit pool anyway. Even the individual market isn't the 'shit pool'. Just when you get into very small businesses and especially individuals, you get hyper anti-selection where people choose to run without insurance until something happens and then they try to buy in. The individual market has dealt with this by having very low rates for young and healthy, excluding pre-existing conditions and denying coverage. The last two were necessary to keep the young and healthy on and not cause a spiral (as you alluded to).

In the very small group market is isn't too bad because the numbers that stay out until they need care are much smaller -- but it's guaranteed issue (at least where I've worked) so they can do it -- and they do. I've seen it plenty. They'll even risk getting denied by lying on their health questionaires just to get lower premium when the most they get is max rated (85% higher than the lowest rate).

What was my point? Oh yeah, the mandate and getting everybody covered and having all insurers on the same rules should mitigate the cost spirals.

I call them the shit group because none of the insurers want them. This is reflected in their rate increases. Small groups are hit with huge increases, while the big guys aren't. If these carriers are forced to accept everyone, this will be passed on to small groups until they can't bear it anymore.

Here is my wife's take on it:
Good news is that some parts of this reform are very good (no pre-ex) and some are very bad (reform does nothing about current healthcare that's already too exp). The even better news is that this bill secured my job for the foreseeable future.

The general consensus at her work is that brokers will be needed more than ever. Nobody is going to understand this shit.

Here is a Cliff's Notes version of a memo they got today:

1. Will extend healthcare to 32 million 'mericans
2. Expand Medicaid program for those not able to buy insurance(who knows what $$ cut off that will be?)
3. Impose new taxes on ins. companies, medical device companies, pharma, and individuals making over $200K- couples over $250K. ( How will this not drive up the cost of care? Those companies are not charities.)
4. Bar practices excluding pre-existing conditions.

Here are the proposed changes-
1. This will kick in for employers- Jan 1 2011 (someone wondered why the stock prices jumped? There is your answer- the insurance companies will cover their asses for 3 years with your company rates)
2. Lifetime benefit maximums will be killed-(Good thing)
3. Group plans will be required to cover adult children up to 26-(another good thing, but we will pay for it and it will hurt businesses)
4. Prevents insurers from rescinding coverage.(Good)
5. Small business -less than 25- tax credits-(good)
6. Retiree coverage through companies that don't have it due to costs(it will still cost business.)

There are a couple other future things, but that is it in a nutshell.


I have no agenda, except I want my wife to keep her job. Most of this is positive, but it will hurt businesses. Good to see them protecting the small guys and the entrepreneurs that have built this country, but I have to believe this will affect the bottom lines of all of our biggest employers.

The Medicaid thing is what has docs in the cold sweats. I won't go into detail, but you think getting paid by insurance companies is a headache for docs? Medicaid is a nightmare- why do you think many docs won't take it? Will they be forced? Who will pay for a doctor waiting a year for payment from 50% of his patients? Where is the provision keeping the older docs from cashing in and moving to Tahiti? I fear a much bigger crises is on the horizon as refers to doctors, but that is another conversation.

Hope this post reflects some "thinking before I post". Maybe the ones really thinking just stay out of Poly Ass all together.

Originally Posted by warthog

If we were talking about sculpting, I would bet you know more about it than I do. We talk about this all the time, she has real life insight from experience. How is this not thinking before I post?

They have never been able to sell health insurance across state lines. Most insurance people I now are all for it, because of the increased competition. It is better for their clients to get competitive rates. Where this breaks down is the pooling of individuals. Those small groups will likely get priced right into the pool. Hopefully not, but it is looking likely. No, these will be thousands of people, but the rates might be skewed by the people they "have" to take. What the fear is, is that only the C and D rated insurers will take on this risk. The A and B guys- the ones you want, will only stick to big corps. and the rich. It is a total possibility.

In home insurance, it goes like this. The cheap guys are horrible, and the A and B rated carriers are really pricey. Around here, home insurance costs as much as taxes do. The poor go with the shit carriers, and get screwed if they ever have a claim. The rich pay out there nose, but get great response. What would make this any different with healthcare?

A big yes. My wife's been in the insurance industry since 86' your analogies of healthcare carriers and homeowners (and car insurers) are exactly spot on and will be very evident very soon.