

Obamacare upheld 6-3 by Supreme Court - kbal11
http://www.nytimes.com/2015/06/26/us/supreme-court-affordable-care-act-health-subsidies.html

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hwstar
This ruling is actually very good for individual freedom. I'm happy to see
that the supreme court made an intelligent ruling. I'm 54 and semi-retired. I
have pre-existing conditions and if we went back to the way things used to
work, I'd have to become employed full time again.

I hate everything American employment stands for. Age discrimination,
employment-at-will, invention agreements, covenants not to compete, and
binding arbitration to name a few.

At least now, I can continue to live off my investments and rental income, and
contribute to the open source community in the areas of hardware and software
design.

The taste of freedom is exhilarating!!

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ikeboy
Are you getting subsidies from the government while living in a state that
didn't set up an exchange? If not, this ruling has no effect on you.

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hwstar
I'm in California. A state with its own exchange.

If this ruling had gone the other way, it would have affected me eventually. I
would not expect Congress to do anything, and the state of California may not
have been able to react quick enough with state legislation to stabilize
things.

There would have been a domino effect as more people in red states cancelled
their insurance and left only the very sick with insurance. The effect would
have reached the states with their own exchanges. The whole thing would have
likely collapsed.

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ikeboy
I don't get why it would affect other states. The only people cancelling would
be people who couldn't afford without the subsidies. Are you saying the whole
system only works because of the subsidies? But it wasn't _that_ much worse
before, and all the other provisions would have remained.

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hwstar
Yes, it would be unworkable without the subsidies.

There are 34 states using the Federal exchange. Most of these states are in
the south and midwest. The income per capita in these states is much lower
than the states with their own exchanges. It is estimated that 70% of those
covered would cancel their insurance in these states if the subsidies were
eliminated. The remaining 30% would try to hang on as they probably really
need the insurance due to pre-existing conditions. Insurance companies would
not be able to make a profit off of the remaining 30% and they would raise
unsubsidised rates to try and compensate. As they raised the rates, more
people would drop out and then the insurance companies would start raising
rates in the states with their own exchanges, and on employers who offer
health insurance to employees to compensate. The whole thing would have come
crashing down.

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ikeboy
Why are the people getting subsidies and are poor also the ones the insurance
companies are profiting most off of? If you don't assume such a correlation,
then the worst that will happen is a slightly smaller economy of scale.

Am I missing something?

Also, if an insurance company is losing money in a state, stopping to service
that state is strictly better for profits than continuing and raising money by
raising prices elsewhere. One state shouldn't affect others like that.

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MichaelCrawford
Without obamacare i would have no coverage at all. i dont object to paying for
traditional health insurance but before obamacare i could not qualify as i
have too many preexisting conditions.

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transfire
Just about everyone agrees with the preexisting conditions aspect of the law.
The problem with the law is much bigger than that however. I'll try to break
down some of the issues to clarify.

1\. The law institutionalizes a broken insurance and pharmaceuticals system
that puts profits about health outcomes.

2\. Because of high deductibles, the employed poor are paying for care they
cannot afford to use, in effect subsidizing the upper classes who can.

3\. Dependents become a burden to tax payers b/c they are now responsible for
their health coverage. (Think unemployed granddaughter who lives with, but
also helps take care of, her grandmother.)

4\. Administrative requirements are out-of control. And digital record systems
are proving to be a complete disaster (thanks to lousy regulations).

5\. The system continues to perpetuate employee provided care.

6\. It unfairly burdens the young to placate the old.

I am sure others can add to this list.

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hwstar
Point 1 I agree on, the others not so much.

2\. Not true. The co-pays and deductibles for low income people are
subsidized. Some pay as little as $5 to see the doctor or get a name brand
prescription drugs.

3\. The system was designed to spread the risk. This is by design.

4\. Not really. I don't have any trouble seeing a doctor when I need one due
to red tape.

5\. No. It does the opposite. It offers freedom from employment for those who
work for 35 years and acquire assets to live off of.

6\. Historically, the young have always supported the old in human society
since the beginning of time. There's no logical reason to change that deal.

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transfire
2\. Cost sharing only operates in a very limited window of income. One must
also buy a Silver plan which costs more (offsetting some of the cost share)
and these plans are highly restricted to in-network doctors and hospitals.

3\. And the effect is to destroy family bonds.

4\. It's not just about seeing a doctor, but the additional costs. Do you know
the average doctor has 7 minutes per patient per visit in order to be
profitable?

5\. People who work 35 years soon get Medicare. For everyone else one still
has to contend with getting new coverage when one leaves their job.

6\. That makes it okay to institutionalize? You missed the word "unfairly".
The ACA goes beyond what is natural. We are going to tax 18 year olds to pay
for grandmom's $500,000 cancer medicine so she can live an extra 4 months?

