The Sad Case of the Patient Protection and Affordable Care Act

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Other prominent Republican governors, including Florida’s Rick Scott, Louisiana’s Bobby Jindal, South Carolina’s Nikki Haley and Wisconsin’s Scott Walker, have previously declared their states would opt out of President Obama’s healthcare law.

There are currently no written penalties here...and it didn't take long for them to bail on our foundational blueprint. You can tell just how important the US Constitution is to a politician if they have the option to ignore it and do so.

Governor Crisco over in the garden state has also pitched his little fit about this. You can tell he's salivating at a national shot -- this time last year he was talking about the TPers as "idiots." Now he's bending knee to them.

[dxmnkd316]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Governor Crisco over in the garden state has also pitched his little fit about this. You can tell he's salivating at a national shot -- this time last year he was talking about the TPers as "idiots." Now he's bending knee to them.

Come ne Kepler, don't you think fat jokes are a bit below you?

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I like the continuing attempt out of our knuckledragging friends to frame a crushing defeat as some sort of victory. I'll have to try that the next time I discuss last year's Super Bowl with a Giants fan.

Rick Perry can refuse to implement exchanges all he wants. The Feds will do it for him. He has no power to stop that so he's merely grandstanding despite the tingly feeling he seems to be giving several USCHO conservatives out here. Same with Rick Scott and Bobby Jindal. So this is a nothing issue basically. In Rick Scott's case he's not going to be around past 2014 given his rock bottom approval rating so I wouldn't worry about him having too much influence in all this.

Regarding Medicare enrollment, that's up to the voters. If you want to sit back and pay taxes for other states to enroll its citizens so your governor can get a regular gig on Fox be my guest. As a "donor" state this will result in a much needed correction as wealthy liberal states tend to subsidize lazy conservative ones.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Come ne Kepler, don't you think fat jokes are a bit below you?

He's an ivy leaguer. He thinks everything's below him.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

There's one thing I do want to bring up. From this article: http://www.nypost.com/p/news/local/c...CCGVPDRmvqZryN

"The US Supreme Court ruled that the Obama administration cannot withhold all Medicaid payments to states to force participation in the expansion, as the law originally prescribed."

They can't withhold all of it, but I think the chances are pretty good that the Federal government will look to withhold a PERCENTAGE of Medicaid payments to states, and the judges will find that to be OK. Look at what they did (and still do) with Federal Highway funding when it came/comes to the national speed limit (since repealed), the drinking age, and open container laws. I would bet an AIC jersey for Dirty that this will happen again.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

He's an ivy leaguer. He thinks everything's below him.

Not everything.

ECAC Hockey Men - 2011-2012 Standings

Conference Only Overall
Pts GP Record Win% GF- GA GP Record Win% GF- GA
1 Union 32 22 14- 4- 4 .727 76- 38 41 26- 8- 7 .720 143- 75
2 Cornell 30 22 12- 4- 6 .682 66- 46 35 19- 9- 7 .643 100- 79
3 Harvard 25 22 8- 5- 9 .568 61- 59 34 13-10-11 .544 106-100
4 Colgate 23 22 11-10- 1 .523 72- 67 39 19-17- 3 .526 121-113
4 Quinnipiac 23 22 9- 8- 5 .523 60- 57 40 20-14- 6 .575 122- 98
6 Yale 22 22 10-10- 2 .500 74- 61 35 16-16- 3 .500 123-106
6 Clarkson 22 22 9- 9- 4 .500 57- 60 39 16-17- 6 .487 105-109
8 St. Lawrence 21 22 10-11- 1 .477 50- 64 36 14-19- 3 .431 88-120
9 Dartmouth 19 22 8-11- 3 .432 63- 74 33 13-16- 4 .455 93-102
10 Rensselaer 17 22 7-12- 3 .386 43- 61 39 12-24- 3 .346 78-111
11 Princeton 16 22 6-12- 4 .364 58- 72 32 9-16- 7 .391 85-105
12 Brown 14 22 5-13- 4 .318 54- 75 32 9-18- 5 .359 75- 97

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

There's one thing I do want to bring up. From this article: http://www.nypost.com/p/news/local/c...CCGVPDRmvqZryN

"The US Supreme Court ruled that the Obama administration cannot withhold all Medicaid payments to states to force participation in the expansion, as the law originally prescribed."

They can't withhold all of it, but I think the chances are pretty good that the Federal government will look to withhold a PERCENTAGE of Medicaid payments to states, and the judges will find that to be OK. Look at what they did (and still do) with Federal Highway funding when it came/comes to the national speed limit (since repealed), the drinking age, and open container laws. I would bet an AIC jersey for Dirty that this will happen again.

A fair point. Especially given the precedents you mentioned particularly highway funds & drinking age. I keep coming back to the unrealistic attitude some people are trying to take. If this is all "la-dee-da we don't have to implement it" why are the same people telling us that its imperative Willard Mittens Romney be elected President in order to repeal healthcare?

So, lets say in Florida Rick Scott refuses to expand Medicaid. Great but these working poor people still have to get insurance or get clipped on their tax return so they'll be using the exchanges. I saw an estimate of a million citizens (recall this bill doesn't affect illegals). Given that children generally already have health coverage, its an easy assumption that these million people are of voting age. Anybody else see a problem here? You HAVE to get insurance or pay up, but your governor has decided to REFUSE federal funding so now you're paying more for the insurance. I wonder how well these million people plan on rewarding the governor for this.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

There's one thing I do want to bring up. From this article: http://www.nypost.com/p/news/local/c...CCGVPDRmvqZryN

"The US Supreme Court ruled that the Obama administration cannot withhold all Medicaid payments to states to force participation in the expansion, as the law originally prescribed."

They can't withhold all of it, but I think the chances are pretty good that the Federal government will look to withhold a PERCENTAGE of Medicaid payments to states

I thought the idea behind that ruling was that the government still had to provide all non-expansion funding -- base program funding cannot be made contingent on accepting the expansion.

The Con law guy I heard on POTUS after the ruling said that is suspect reasoning, because when the states sign up for Medicare the contract says the feds can change the rules any time they want.

[dxmnkd316]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I thought the idea behind that ruling was that the government still had to provide all non-expansion funding -- base program funding cannot be made contingent on accepting the expansion.

The Con law guy I heard on POTUS after the ruling said that is suspect reasoning, because when the states sign up for Medicare the contract says the feds can change the rules any time they want.

That's my understanding as well. If the government was providing $100 before, and they are offering an additional $50 if you take the new program, you can't take away any of the original $100 if you refuse the $50.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I thought the idea behind that ruling was that the government still had to provide all non-expansion funding -- base program funding cannot be made contingent on accepting the expansion.

The Con law guy I heard on POTUS after the ruling said that is suspect reasoning, because when the states sign up for Medicare the contract says the feds can change the rules any time they want.

One thing I have learned as an engineer: Never assume a negative case. The only thing that was said was that 100% of funding cannot be withheld. Giving $1 for Medicaid funding to specific states still falls under the paradigm that 100% of funding is not withheld.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

A fair point. Especially given the precedents you mentioned particularly highway funds & drinking age. I keep coming back to the unrealistic attitude some people are trying to take. If this is all "la-dee-da we don't have to implement it" why are the same people telling us that its imperative Willard Mittens Romney be elected President in order to repeal healthcare?

So, lets say in Florida Rick Scott refuses to expand Medicaid. Great but these working poor people still have to get insurance or get clipped on their tax return so they'll be using the exchanges. I saw an estimate of a million citizens (recall this bill doesn't affect illegals). Given that children generally already have health coverage, its an easy assumption that these million people are of voting age. Anybody else see a problem here? You HAVE to get insurance or pay up, but your governor has decided to REFUSE federal funding so now you're paying more for the insurance. I wonder how well these million people plan on rewarding the governor for this.

This is something I hadn't thought of.

http://www.medscape.com/viewarticle/766583 Article in one of the ejournals I get. The first part is kind of no brainer if you work in primary care. The last section talks about practices that don't do high volume getting left behind. This is kind of scary as the medical economics journals are showing statistically sig decrease in productivity after implementaion of electronic med records which is is being pushed hard. I believe it is part of the Act and even if it isn't the insurance companies are docking big $ if they aren't used. (One is paying 20% less per visit). The risk management industry also have shown 'high' volume (>15 pts a day) increases the rate of error and adverse outcome.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I thought the idea behind that ruling was that the government still had to provide all non-expansion funding -- base program funding cannot be made contingent on accepting the expansion.

The Con law guy I heard on POTUS after the ruling said that is suspect reasoning, because when the states sign up for Medicare the contract says the feds can change the rules any time they want.

Perhaps, however this portion of the ruling was 7 - 2; Kagan and Breyer joining Roberts, Kennedy, Scalito, and Thomas. If a state refuses the expansion, then they do not forfeit what they are already receiving.

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Perhaps, however this portion of the ruling was 7 - 2; Kagan and Breyer joining Roberts, Kennedy, Scalito, and Thomas. If a state refuses the expansion, then they do not forfeit what they are already receiving.

Correction: they do not forfeit everything that they were receiveing. Big difference.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Correction: they do not forfeit everything that they were receiveing. Big difference.

Here's what Chief Justice Roberts had to say... the very last sentence of the quote seems pretty clear to me: Existing Medicaid funding is fully protected. Read for yourself and see if the English language means the same thing to you as to me:

The States, however, argue that the Medicaid expansionis far from the typical case. They object that Congress has “crossed the line distinguishing encouragement from coercion,” New York, supra, at 175, in the way it has structured the funding: Instead of simply refusing to grant the new funds to States that will not accept the new conditions,
Congress has also threatened to withhold those States’ existing Medicaid funds. The States claim that this threat serves no purpose other than to force unwilling States to sign up for the dramatic expansion in health carecoverage effected by the Act.

Given the nature of the threat and the programs atissue here, we must agree. receipt of funds on the States’ complying with restrictions on the use of those funds,because that is the means by which Congress ensures that the funds are spent according to its view of the “generalWelfare.” Conditions that do not here govern the useof the funds, however, cannot be justified on that ba- sis. When, for example, such conditions take the form of threats to terminate other significant independent grants,the conditions are properly viewed as a means of pressuring the States to accept policy changes. [emphasis added, particularly the word "independent"]

.....

In this case, the financial “inducement” Congress haschosen is much more than “relatively mild encouragement”—it is a gun to the head. Section 1396c of the Medicaid Act provides that if a State’s Medicaid plan doesnot comply with the Act’s requirements, the Secretary ofHealth and Human Services may declare that “further payments will not be made to the State.” 42 U. S. C. §1396c. A State that opts out of the Affordable Care Act’s expansion in health care coverage thus stands to lose not merely “a relatively small percentage” of its existing Medicaid funding, but all of it. Dole, supra, at 211. Medicaid spending accounts for over 20 percent of the average State’s total budget, with federal funds covering 50 to 83 percent of those costs.....In addition, the States have developed intricatestatutory and administrative regimes over the course of many decades to implement their objectives under existing Medicaid.....The threatened loss of over 10 percent of a State’s overall budget, in contrast, is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion.

The States contend that the expansion is in reality a new program and that Congress is forcing them to accept it by threatening the funds for the existing Medicaid program. We cannot agree that existing Medicaid and the expansion dictated by the Affordable Care Act are all one program simply because “Congress styled” them as such. Post, at 49. If the expansion is not properly viewed as a modification of the existing Medicaid program, Congress’s decision to so title it is irrelevant. [emphasis added]

...

The Medicaid expansion, however, accomplishes a shift in kind, not merely degree. The original program was designed to cover medical services for four particular categories of the needy: the disabled, the blind, the elderly, and needy families wit dependent children. See 42 U. S. C. §1396a(a)(10). Previous amendments to Medicaid eligibility merely altered and expanded the boundaries of these categories. Under the Affordable Care Act, Medicaid is transformed into a program to meet the health care needs of the entire nonelderly population with incomebelow 133 percent of the poverty level. It is no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage. [emphasis added]

Indeed, the manner in which the expansion is structured indicates that while Congress may have styled the expansion a mere alteration of existing Medicaid, it recognized it was enlisting the States in a new health care program. Congress created a separate funding provision to cover the costs of providing services to any person made newly eligible by the expansion. [emphasis added]

What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding. [emphasis added]

Doesn't this last sentence seem pretty clear and unequivocable??



http://online.wsj.com/public/resourc...otushealth.pdf, starting on the page marked 45 in the upper right corner.

[unofan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Here's what Chief Justice Roberts had to say... the very last sentence of the quote seems pretty clear to me: Existing Medicaid funding is fully protected. Read for yourself and see if the English language means the same thing to you as to me:



Doesn't this last sentence seem pretty clear and unequivocable??

Like there aren't plenty of end-arounds of that one. Congress can decide to "end" the current Medicaid regime and start a "new" program called Medidollars. Wala, problem solved.

Point being, until this particular ruling gets used for more things (like speed limits, drinking age, etc.), at this point its all bark and no bite.