<p>Senator Baucus also predicted an ACA train wreck before quietly retiring. I agree with everyone, surprisingly. </p>
<p>I gave up on the Supreme Court when they ruled this turkey was constitutional by calling a penalty a tax, even though the Administration was arguing the opposite.</p>
<p>@TatinG – there is not a single word referencing tax credits in that video you posted. Did you even check it out before posting? It’s a discussion about an unspecified amendment, medicaid, and coverage requirements. Look at the transcript - it’s just a random snip from random hearing at a time when the committee was going through hundreds of amendments. </p>
<p>Actually, to pick up even more on what Cardinal Fang said–this is why the Supreme Court will probably not hold that people on the federal exchanges can’t get subsidies. It would essentially result in a huge tax increase, but only on people in Red states. It won’t be possible to simultaneously claim that this was what Congress intended and also say that this invalidates the whole law. Who would actually be in favor of this result? The individual mandate would remain in place, in all the states.</p>
<p>Calmom and Hunt, isn’t the (starting) point that the law is what was passed, not what some politician chooses to say, after the fact? Ie, we work with “what is,” not all the subsequent chatter-?</p>
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</p>
<p>I hadn’t even thought about the mandate. So low-income people in, say, Mississippi would be told: “You must buy health insurance, and you must pay full price.” ??</p>
<p>Geez, what a mess. And all because someone decided to take an obvious typo literally.</p>
<p>Although I didn’t agree with the Supreme Court decision, I think what Roberts was really saying is that elections have consequences and the people generally have to live with the laws their elected representatives write. He is right about this: if the American people want to change this law, they will have to do it at the ballot box.</p>
<p>States that wanted their residents to get the subsidies could “establish” a state exchange trivially.Oregon and other states could simply buy a website, redirect to the fed site, and call that establishing an exchange. And then their residents would continue to have subsidies.</p>
<p>On the other hand, states that deliberately wanted to deprive their residents would be able to do so, if the Supremes decided for Halbig. But it’s an interesting question whether ripping subsidies away from millions of people who now have them would prove to be a popular political move.</p>
<p>CF, the law is pretty explicit about what is required for an exchange. It’s got nothing to do with a URL. </p>
<p>The state of California now has a website for their exchange. What’s the difference between that, and a hypothetical Oregon page that just silently sends everything off to the federal site?</p>
<p>
That seems to be what would happen under this interpretation of the law. It’s pretty surprising that opponents of the law are trying to say that this is what was intended. Perhaps when they think it over a bit more, they might have some second thoughts about this.</p>
<p>Well, what they are saying was intended was that all states set up exchanges. I think they understand the law was poorly crafted and has a lot of unfortunate unintended consequences, though.</p>
<p>CF, the word “exchange” does not mean “web site”. I’ve put in a lot of effort to find citations and explain the text of the law. I don’t have time to respond to silliness. You can look up the definition and requirements for an “exchange” yourself. It’s going to be in section 1311 or 1321. I posted the links to those sections previously. </p>
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</p>
<p>This is what I’m clinging to, Hunt. Not that I think opponents of the law much care about millions of people suddenly losing their healthcare, but I’m hoping John Roberts will think along those lines.</p>
<p>Although… if Halbig is indeed upheld, I think the next step will be [the option which must not be named]. But that would take some time, and there would be untold suffering in the meantime.</p>
<p>Here’s the relevant text:
<a href=“4”>quote</a> FUNCTIONS.—An Exchange shall, at a minimum—
(A) implement procedures for the certification, recertification, and decertification, consistent with guidelines developed by the Secretary under subsection ©, of health plans as qualified health plans;
(B) provide for the operation of a toll-free telephone hotline to respond to requests for assistance;
© maintain an Internet website through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on such plans;
(D) assign a rating to each qualified health plan offered through such Exchange in accordance with the criteria developed by the Secretary under subsection ©(3);
(E) utilize a standardized format for presenting health benefits plan options in the Exchange, including the use of the uniform outline of coverage established under section 2715 of the Public Health Service Act;
(F) in accordance with section 1413, inform individuals of eligibility requirements for the medicaid program under title XIX of the Social Security Act, the CHIP program under title XXI of such Act, or any applicable State or local public program and if through screening of the application by the Exchange, the Exchange determines that such individuals are eligible for any such program, enroll such individuals in such program;
(G) establish and make available by electronic means a calculator to determine the actual cost of coverage after the application of any premium tax credit under section 36B of the Internal Revenue Code of 1986 and any costsharing reduction under section 1402;
(H) subject to section 1411, grant a certification attesting that, for purposes of the individual responsibility penalty under section 5000A of the Internal Revenue Code of 1986, an individual is exempt from the individual requirement or from the penalty imposed by such section because—
yadda yadda
(J) provide to each employer the name of each employee of the employer described in subparagraph (I)(ii) who ceases coverage under a qualified health plan during a plan year (and the effective date of such cessation); and
(K) establish the Navigator program described in subsection (i).
[/quote]
</p>
<p>I don’t see why the state couldn’t “establish” an exchange by providing a pass-through to the federal exchange. That is, their “procedure” for certifying and decertifying could be “have the Feds do it,” their website could be a pass-through, they could establish the Navigator program by having the Feds do it, and so forth.</p>
<p>This could be a problem, though:
<a href=“5”>quote</a> FUNDING LIMITATIONS.—
(A) NO FEDERAL FUNDS FOR CONTINUED OPERATIONS.— In establishing an Exchange under this section, the State
shall ensure that such Exchange is self-sustaining beginning on January 1, 2015, including allowing the Exchange to charge assessments or user fees to participating health insurance issuers, or to otherwise generate funding, to support its operations.
[/quote]
</p>
<p>OTOH, whatever (small) costs the state would have under this pass-through scheme could be state-funded with ease.</p>
<p>Re the Oregon situation:</p>
<p><a href=“Oregon Dumps Failed Health Insurance Exchange”>Oregon Dumps Failed Health Insurance Exchange;
<p>I don’t think it would work, CF. I think that language requires the states to actually do all those things. There are provisions for multi-state exchanges, so they could band together and do that. I guess they could hire the same contractors the feds used…</p>
<p>This what we’re talking about on the ground, in terms of real people:</p>
<p>[4.7</a> Million People Could Lose Subsidies](<a href=“Businessweek - Bloomberg”>Businessweek - Bloomberg)</p>
<p>These are people who will have had insurance for more than two years by the time SCOTUS rules, if it takes the case. Low income people who could never afford insurance without subsidies and who, as Hunt points out, will nonetheless be required to have it. I just wonder what Mr. or Ms. Halbig thinks those people are supposed to do.</p>
<p>CF, a state can work in partnership with the federal government to set up an exchange if they choose to do so. But it’s not something that the state does unilaterally – it involves a formal agreement. Here’s a good article from 2013 explaining the options: <a href=“State Health Insurance Marketplace Types, 2023 | KFF”>http://kff.org/health-reform/issue-brief/establishing-health-insurance-exchanges-an-overview-of/</a> </p>
<p>^ I’m seeing that the law they passed is the law we have to deal with.
Malkin’s praise reflects the very conservative nature of the blog.</p>