I used to be HIGHLY skeptical of the HCR. Then this happened. And now I support it 100%

[Taverner]

Some of us just don't get it. Now that the mandate has become a tax, instead of a mandate like car insurance, it is collected by the government. It is the job of the IRS to enforce said mandate.

Collected by the government means Single Payer has now been raised from the dead - because now this is in the hands of the government. They will ensure (1) all Americans are covered, vis a vis the HRC and (2) all Americans pay their taxes, like they always have.

This means we might, if we play our cards right, get SINGLE FUCKING PAYER - since the government agencies are more empowered to make this happen.

Of course, Republicans, this is exactly what you fear it is: a tax increase. Something I think we have needed since Reagan moved in and fell asleep in the White House.

[Whisp]

1. yep. nt

[wiggs]

2. Yes. Obama always said this is a starting point. nt

[Taverner]

6. And now, it really is a starting point

It wasn't in my opinion, before this decision

[patrice]

3. Remember: It's the PATIENT PROTECTION and Affordable Care Act.

[aquart]

4. But doesn't the law specifically forbid enforcement?

[nanabugg]

22. It prohibits CERTAIN methods of enforcement. But if it is a tax, then IRS has enforcement authority

let's just see what happens.

[bluestateguy]

5. The argument that judicial nullification would have paved the way for single payer was laughable

Had this bill been overturned, nothing would have replaced it. Nothing would be done for decades and we'd be right back to the way things were before it was passed, and things would have started getting worse again.

The prospects for single payer someday at least has a fighting chance if this bill is upheld because it embraces the idea that health insurance is a right. Yes, it's private insurance, and that is not what we prefer, but it is a start.

[slackmaster]

7. I am mostly in agreement with your analysis, but have a slight twist to offer

Because a sub-set of the people will be in a position to choose between paying for a regular insurance policy out-of-pocket and paying the tax and accepting what will be offered through a state-run insurance pool, there is a possibility that there will be competition between the private insurers and the government pools.

It will take several years before it becomes clear where things are really headed. If private insurers really got their act together they could give government-managed pools a run for their money. That could potentially be the best of both worlds - Coverage for everyone regardless of means, and real choices for many.

[quinnox]

8. I doubt it

I think that the only way to get a real health care system that is affordable will be through individual states doing it themselves at this point, and if you are lucky enough to live in a liberal state then you might get a medicare for all system eventually.

[Taverner]

10. The way things are set up now, that could very much become a reality

[Schema Thing]

9. huh? this changes nothing. but you are right to be for it.

the law has, from the beginning, had the makings of 50 state-wide single-payer systems.

[Taverner]

11. As a mandate, like car insurance, the government only needed proof that you had health insurance

Now that it is a tax, that means that even if it is not collected now, the IRS will ensure the money is collected.

The IRS being the IRS, I don't expect them to live with a middle man for too long. Soon this will be another deduction like SS and FICA. And now that this establishes health care as a right - an insurance company has no choice but to pay for life-saving care.

We're better off now than we were before.

[Lionessa]

12. The mandate didn't become a tax. It is being compared to a tax, but it isn't a tax.

Taxes go to the gov't. The mandate still goes to private for-profit insurance companies.

So though I'm usually right there with your explanations, this one falls way short, or I'm not understanding what you're trying to impart.

Are you saying that because of the analogy, it gives the gov't a right to take it over as a tax someday? That's the closest guess I have to what you're saying. Please correct my misunderstanding.

[Harmony Blue]

14. The mandate became a tax based on the USSC ruling

please pay attention to what has happened today. Thank you!

[Lionessa]

16. No it did not. You are mistaken. It was compared to a tax to justify it, but it isn't being

paid to the government, so it isn't a tax, it's a mandate.

[Harmony Blue]

19. It is a tax

and those that choose not have insurance will see it when tax time arrives. You are wrong.

[Lionessa]

24. You just don't get it, even if those who don't have insurance pay the tax, they don't get healthcare

or health insurance, do you get that? It isn't a tax, it's a penalty being called a tax.

And the mandate, if one follows that course, is a mandate to pay a private company for insurance, not a tax to provide healthcare through the gov't.

I'm sorry if these subtleties confuse you, unfortunately most Americans seem easily confused and hence we are in the mess(es) we are in. I know we like to imagine that only Repubs have their easily manipulated folks, but they're on both sides of the aisle. Those supporting this are ours.

[JDPriestly]

54. Nowadays, so much is privatized especially in the military and now with charter

schools, that the fact that the taxes will be paid to private companies is nothing new.

Right now, the money that goes to charter schools goes, primarily to supposed non-profits. It's just a matter of time until the charters become for-profit institutions, some of which will have corporate sponsors.

Welcome to the corporate state. Let's continue to work toward, first a public option and then single payer. Let's try to require health insurance providers to be run as most of them once were, as true non-profits.

[Prism]

13. Democrats and Republicans won big today

The ACA was upheld - Democratic win

The Commerce Clause just got crucified - Republican win.

When the headlines settle and the implications of the precedent set in, I don't think people are going to be as thrilled as they are now.

I honestly think Chief Justice Roberts just outmaneuvered the hell out of everyone. He just curtailed a lot of federal power, and no one seems to realize it. Then again, I don't expect the media or most partisans to be the most perceptive of people.

This was a legal revolution on his part. I'm shocked so few are paying attention to it.

[Harmony Blue]

15. The Commerce Clause was too ambigous

the USSC pretty much openly says it is a clear tax.

[Prism]

21. This has to do with the Medicaid expansion

How the Chief Justice's opinion blocked federal penalties regarding the Medicaid expansion affects how the federal government compels states to enact policy. A lot of funds/penalties levied by the federal government on the states have these various strings attached in order to more or less force states to adopt a national policy.

Roberts' opinion just severed a nice bundle of those strings.

If you're a states' rights advocate, this is a big deal.

[phantom power]

17. I am completely failing to see why "they will ensure all Americans are covered"

Serious question: am I missing something? Yes, the govt now will (eventually) collect money from people who choose the 'penalty tax'. Is there some language specifying how that money is to be used?

Also, whatever "paths" there might be from ACA to Single Payer, let's all bear in mind that:

1) there are also "paths" from ACA to a dystopian corporatist system where we keep the penalty-tax/mandate, and further erode public coverage. This is not just hypothetical - remember all the 'austerity' talk that is embraced by both the GOP and unfortunately some Dems too.
2) the GOP will fight for those paths, and against ours
3) the insurance industry will fight for those paths, and against ours. And ACA just created a penalty for not giving business to the insurance industry.

[HiPointDem]

18. who is paying the tax? how does that work, exactly?

[Harmony Blue]

20. If you have insurance already you do NOT pay a tax

If you don't have insurance and you don't quality for the exemptions:

1. You pick an insurance plan from a market place set up by your state you claim residence of.

or

2. You pay the tax "penalty" to not buy health insurance which goes to the government.

[HiPointDem]

23. i see. and where are large corporations taxed? or is it all on the backs of individuals?

[Harmony Blue]

25. They too have to choose

The tax or insurance plans.

Some businesses may opt for one choice over another. But for those individuals working at a business not offering a plan, now they will have a choice through the marketplace set up by the state to buy individually.

Huge win for the consumer.

[HiPointDem]

27. so corporations *have to* buy plans for their employees? or they can just give them a voucher

and tell them to buy their own?

[Son of Gob]

56. Here

Under the Affordable Care Act, beginning in 2014 employers with at least 50 full-time employees (or equivalent full- and part-time workers) will have to provide “qualified” health insurance coverage to their full-time employees and their dependents. Qualified coverage means that plans are comprehensive (pay at least 60 percent of health care expenses) and affordable (cost less than 9.5 percent of employees’ household incomes).

If employers don’t offer qualified coverage, and if their employees purchase coverage instead through a new state insurance exchange with the assistance of federal subsidies, companies will have to make an “assessable payment” of up to $2,000 for every full-time employee beyond the first 30 employees. The amount of the assessment will be adjusted annually to reflect the growth in national insurance premium costs.

If employers do offer coverage, but the coverage does not meet certain parameters, they may still have to pay assessments. First, employers will be assessed if a plan is judged not to be comprehensive. This means the coverage must have an “actuarial value” of at least 60 percent. In other words, the employer pays on average at least 60 percent of health care expenses and the employee pays on average 40 percent of these expenses through deductibles and copayments.

Second, employers will be assessed if the employees’ premiums are considered unaffordable relative to their household incomes. Specifically, the employee’s share of the premium must not exceed 9.5 percent of his or her annual household income.

Starting in 2014, if either of these two conditions is not met, the employer must pay a $3,000 annual assessment for each employee who declines his or her employment-based insurance and obtains government-subsidized coverage through an exchange.

http://pnhp.org/blog/2011/03/15/employer-sponsored-health-plans-under-the-affordable-care-act/

[HiPointDem]

59. thanks for the link. i forsee a lot of corps dropping their health care policies. Seems like

$166/mo must be cheaper than what some are paying now.

To get 60% coverage?

jeez. aim low.

[Lionessa]

26. This is not correct, the tax doesn't get you a health insurance plan, it just doesn't, it's a

PENALTY that uninsured will pay to support the states setting up the market place, it DOES NOT give anyone insurance directly.

[HiPointDem]

28. so you pay the tax but still get no insurance? so how about people with no income (e.g. homeless)

-- how do they access care?

[Lionessa]

29. Same as those that don't have insurance and pay the tax, ER only.

[HiPointDem]

32. so basically the very poor would be in the same place they are today?

[Harmony Blue]

33. No they quality for the exemption and will be part of Medicaid

don't be mislead.

[HiPointDem]

36. i just read that some states were saying they wouldn't expand medicaid, & it seems the SC said

they didn't have to.

it's very confusing.

[Harmony Blue]

40. While that may be true

they will eventually have to expand or offer more options through the marketplace. You must also understand that policy takes time to put in place. The Clean Air Act took a long time to be put in place because states had to carve out a budget to enact such a policy and they asked for extensions. But it eventually did become a reality and states had to adjust their budgets accordingly.

This will be no different, and they can resist all they want, just like the Clean Air Act, but they will eventually cave.

[HiPointDem]

45. um, when does the requirement to buy insurance come into effect?

[Harmony Blue]

47. I believe it is 2014

if I recall correctly.

[Lionessa]

35. As well as many working poor who still won't be able to afford insurance, but will be penalized by a

"tax."

[Harmony Blue]

41. The tax is not a flat tax across the board

and it varies on income level. Furthermore, the working poor will quality for exemptions. If you mean middle class Americans who choose not to have insurance plan, yes they will be taxed.

[HiPointDem]

46. define "middle class"

[Harmony Blue]

48. U.S. definition or U.N. definition?

I will go with the IRS definition, and it is clear what they consider middle class. Anyone well above the poverty level.

[HiPointDem]

51. give me an income figure. "well above the poverty level" tells me nothing, and in fact, i don't

believe there is an irs definition of 'middle class'.

[HiPointDem]

42. yeah, this is the part i'm not seeing how it works -- but i'm feeling like this will eat up their

pitiful little irs refund.

and i dunno, if the insurance plans they can afford to buy into are anything like the ones available today, there is going to be a lot not covered & a lot of extra cost when they do get sick.

for a lot of people being uninsured and crossing fingers might be a better financial bet (specially if they're young).

[Lionessa]

52. I think you're getting the gist of it

The USSC basically kept the part the that assures insurance profits, and killed the part that gave gov't a role in assuring the poor and working poor get healthcare.

[Harmony Blue]

34. I never said that it did

What is clear that people will have more options now.

[Lionessa]

38. It seems as though you keep suggesting that the tax will provide insurance, it won't.

And since the Medicaid part of the deal is being trashed, no state even has to set up the exchanges. So there's nothing to assure insurance or healthcare for the indigent or working poor, only a penalty.

[Harmony Blue]

44. I suggested no thing

I clearly laid out what happens if you choose to have a plan or don't (tax).

[frazzled]

30. Technically, the penalty for nonobservance of the mandate is a tax

Not the mandate itself. I think that's important to state. Because everyone is going to think they are having their taxes raised, otherwise. This is a PENALTY for not being covered. If you are already insured through a group plan at work (like 85% of the country), there is no "tax." If you are uninsured or privately insured and receive a credit to purchase the insurance on one of the exchanges, there is no tax. If you qualify for the expansion of Medicaid, and your state decides it is going to cooperate, there will be no tax.

For the few scofflaws left who just don't want to get themselves covered (and are not among the excluded), a penalty will be applied, enforceable through the IRS, who can take it out of any refund you're owed (or possibly other ways).

[HiPointDem]

39. so how about if you have no job & no income, then say 4 years later get a job. do they come

after you for back "penalties"?

[frazzled]

43. If you have no job and no income you can get Medicaid

for free.

And no, people who are too poor are exempt from any tax penalty.

Jeebus folks, this stuff is all spelled out all over the Internet. I'm not sure why so many don't know the basic provisions. I'm not trying to be mean; I'm just concerned about how little is known about this bill after two years.

[HiPointDem]

49. 'spelled out' = not really. there are lots of permutations. as for medicaid, it's already been cut

back in my state.

http://www.spokesman.com/stories/2011/sep/03/medicaid-cuts-target-er-visits/

[unblock]

31. just to be clear, it was ALWAYS a tax, collected by the irs, paid to the u.s. treasury.

just because the obama administration chose not to present it to the public as a tax doesn't mean that that wasn't what it was all along.

today's ruling didn't change anything about how the tax is collected or to whom it is paid. the law ALWAYS had it collected by the irs and paid to the u.s. treasury.


private insurers benefit (just as solar panel and hybrid manufacturers benefit) from the offsetting credit for having qualifying health insurance, which encourages people to buy insurance, but the tax itself (aka the "penalty&quot is and always was collected by the irs and paid to the u.s. treasury.

[Harmony Blue]

37. Correct

but the Commerce angle the USSC was something they weren't buying into so they went a different way with their ruling.

[unblock]

50. right. the only thing that "changed" was the argument. the law itself didn't change.

with the exception of the medicare expansion modification.

[JDPriestly]

53. Agreed. And I have always thought that the mandate needed to be done under

the tax and spend authority. I don't know why Congress didn't do it that way. Maybe because of the Norquist Ninnies.

[JoePhilly]

57. YUP ... they avoided calling it a Tax because lots of bluedogs would have balked.

But the structure of it was always really a tax by another name.

[ieoeja]

55. I'm with you 100%.

I never thought about it that way before. We will have a 1% health care tax with an exemption for those covered by an approved health insurance provider.

I was conflicted on this before. But put that way it is really a baby step towards single payer. Heck, if all those companies pretending they plan to get rid of health insurance because of this were tellling the truth and really did ... that baby would be a juvenile immediately. So many of them are claiming they are going to do this, I wonder if there wouldn't be enough cash in tax penalties to actually provide single payer!

Okay, it probably isn't that big. But it would be interesting to watch.


Now, let me talk to imaginary company owner to see if I can understand their logic.

THEM: "Now that the penalty for not providing my employers health insurance is lower than the cost of providing that care, I am going to stop providing them with insurance."

ME: "Was the penalty before higher than the cost of health insurance?"

"No! There was no f------- penalty!"

"So you provided health insurance when it would have cost you nothing to not provide health insurance. But now that it will cost you if you do not provide health insurance, you are going to stop providing health insurance."

"Exactly!"

"That makes no sense."

"Liberal, commie faggot!"

"Nazi."


Yup. Pretty much ended the way those conversations usually end up in real life. And made just as much sense.

[Occulus]

58. It will be at the least four years before the question is seriously raised.

All of the provisions of the ACA that are not yet in effect kick in in 2014. Nobody in Washington, and I do mean nobody at all, will even entertain serious inquiries as to improvements to the ACA until all of its provisions are enacted.

From that point, Obama will, assuming he is reelected, have two years left in his term. No Democrat, in either the House or the Senate, will approach modifying or "improving" the ACA with a fifty mile pole without Obama's personal blessing. He almost certainly will want the ACA tested "as is"; the ACA, after all, is his personal legacy.

Given that, assuming we get another Democrat in the White House after Obama (an event that hasn't happened in my lifetime), it isn't terribly likely that person will be willing to tamper with a law that has only just taken effect, and is his predecessor's legacy, to boot.

Let me amend my subject line. It will take at least six years to get any improvements to the ACA to be seriously entertained, if those improvements are introduced at all. I have little confidence, or perhaps I mean none at all, that any such changes will be to the benefit of the People and not the industry from whom we are now mandated to purchase a product that we all generally agree is inefficient and substandard.

Single payer and Medicare for all are dead issues for the foreseeable future. It will be a matter of years, at the very least, before the ACA is modified toward either of those goals in any meaningful way.

To claim otherwise is simply naive.