Supreme Court upholds nationwide health care law subsidies

fawnmarie, ASN · Jun 25, 2015

I have been watching the news all morning and was hoping someone would share this on allnurses! What great news!

SC_RNDude · Jun 25, 2015

Where we should go next:

Reforming Obamacare: How Congress, and the President, Can Win after King v. Burwell | NCPA

toomuchbaloney · Jun 25, 2015

Where we should go next:
Reforming Obamacare: How Congress, and the President, Can Win after King v. Burwell | NCPA

It would be refreshing to hear debate within the halls of Congress about improving the ACA. Do you think there will be any hint of these sort of reforms getting traction in either chamber?

To date there seems to have been little stomach in the Republican leadership to debate or vote on anything beyond repeal of the ACA.

SC_RNDude · Jun 25, 2015

It would be refreshing to hear debate within the halls of Congress about improving the ACA. Do you think there will be any hint of these sort of reforms getting traction in either chamber?
To date there seems to have been little stomach in the Republican leadership to debate or vote on anything beyond repeal of the ACA.

It would be refreshing, but I don't think it will happen. I don't think either side believes it would be politically beneficial to do so.

toomuchbaloney · Jun 25, 2015

It would be refreshing, but I don't think it will happen. I don't think either side believes it would be politically beneficial to do so.

Why do you think this?

Why do you think that Democrats might object to reforming some aspects of the ACA?

MunoRN, RN · Jun 26, 2015

Where we should go next:
Reforming Obamacare: How Congress, and the President, Can Win after King v. Burwell | NCPA

From the article:

Reforming Obamacare tax credits for premiums to reduce disincentives for beneficiaries to work more hours and increase their incomes.

I'm all for a more mathematically "smooth" way of calculating the amount of tax credit someone qualifies for, although one of the main arguments of tax code is that using these sorts of equations is too complicated, and that tax code should consist of easier to decipher "brackets", so I don't really see that changing any time soon.

As the article points out, people don't actually lose income by working more, in fact they still make substantially more money by working more, even if working more bumps them into a different tax credit bracket.

One of the most significant changes brought about by the ACA is that there is some "disincentive to work" for workers that have only been working to gain access to employer-sponsored insurance, which is a very good thing. One of the problems with our previous system, is that the only way to gain access to the type of insurance offered through group plans was to get it through an employer, so a number of workers who didn't need the actual income (ie spouses of someone who made plenty of money but didn't get insurance through their employer) were taking jobs from people who did actually need the income.

Combine Obamacare tax credits and cost-sharing subsidies so beneficiaries can decide themselves how much to pay directly for health goods and services versus how much to pay in premiums to health insurers.

Consumers already get to choose how much they pay in a deductible compared to premiums.

Allow beneficiaries to buy health insurance from brokers or agents, instead of the broken exchanges, and receive tax credits directly from the IRS.

Consumers already can buy health insurance through private brokers, although whether or not they could qualify for a subsidy when buying through brokers was challenged by republicans, the Burwell decisions ensures that going forward people can buy plans either off the exchanges of through private brokers.

Remove federal mandates on health insurance, such as age bands and mandated benefits, which increase cost.

As we saw before the lack of these mandates actually increases cost. What they are referring to is that it increases costs for the young and healthy, which in order for our system to work must pay into the system before they start costing more than they put in.

Remove the mandates on individuals and employers to purchase government-compliant health insurance.

As we've seen before the lack of a mandate results in widespread abuse of the system, and also leads to insurance cost "death-spirals", they offer no solution to these established problems which were widely agreed to need fixing prior to Obamacare, which is why conservatives including Gingrich and the Heritage foundation were the biggest proponents of mandates to purchase insurance.

cnmbfa · Jun 30, 2015

From the article:
I
As we saw before the lack of these mandates actually increases cost. What they are referring to is that it increases costs for the young and healthy, which in order for our system to work must pay into the system before they start costing more than they put in.
As we've seen before the lack of a mandate results in widespread abuse of the system, and also leads to insurance cost "death-spirals", they offer no solution to these established problems which were widely agreed to need fixing prior to Obamacare, which is why conservatives including Gingrich and the Heritage foundation were the biggest proponents of mandates to purchase insurance.

The cheap junk insurance -in-name only policies that many on the right find acceptable create a huge problem for the rest of us. When that person finds out that their coverage is worthless and then runs up huge bills that go unpaid, you and I pick up the tab through higher bills from the hospitals on us to recoup the money. Same thing if the person declares bankruptcy.

As for mandates, how do we keep free-riders from avoiding paying premiums, then sticking the rest of us with their bills? And if dry cleaner A does the right thing and insures their employees and Dry cleaner B does not, can't dry cleaner B charge less and push Dry Cleaner A out of business? Is that what we want to see happen?

pmabraham, BSN, RN · Aug 3, 2015

Good day:

"The cheap junk insurance -in-name only policies that many on the right find acceptable create a huge problem for the rest of us. "

The problem on the left is stating that any reasonably priced insurance prior to Obamacare is junk insurance. Why should I as a 52 year old healthy male purchase Obamacare insurance that mandates I have maturity leave coverage, invitro fertilization coverage, along with other completely unnecessary coverage options that just bump up the price of the insurance in order to redistribute wealth?

Now sadly, the issue of King v. Burwell should not have had the outcome it did because the wording was extremely clear subsidies were only to go towards those states that created exchanges. Yet one more time the Supreme court used judicial activism to save Obamacare rather than let the words speak for themselves.

Thank you.

MunoRN, RN · Aug 3, 2015

Good day:
"The cheap junk insurance -in-name only policies that many on the right find acceptable create a huge problem for the rest of us. "
The problem on the left is stating that any reasonably priced insurance prior to Obamacare is junk insurance. Why should I as a 52 year old healthy male purchase Obamacare insurance that mandates I have maturity leave coverage, invitro fertilization coverage, along with other completely unnecessary coverage options that just bump up the price of the insurance in order to redistribute wealth?

Luckily you don't have to worry that an insurance plan will cost more on the false assumption that you will need maternity care since that would be illegal under the law. Insurers must now meet actuarial value requirements. If a plan consists of only 25% of people who may potentially have a baby, pricing the plan based on everyone in the plan potentially having a baby would be illegal, so you're not actually paying for coverage for any of those services that you won't need.

Now sadly, the issue of King v. Burwell should not have had the outcome it did because the wording was extremely clear subsidies were only to go towards those states that created exchanges. Yet one more time the Supreme court used judicial activism to save Obamacare rather than let the words speak for themselves.
Thank you.

To be honest I'm pretty disappointed as well. I wasn't hoping that people in those states would lose the tax breaks on health insurance that those with employer-sponsored plans have always enjoyed, mainly I was curious to see what the conservative plan was for fixing it, what was the plan if SCOTUS ruled the other way?

allnurses Guide · Aug 4, 2015

Poll: ObamaCare enrollees less satisfied with insurance plans

The poll from the Deloitte Center for Health Solutions, the research arm of the consulting firm, finds that 30 percent of people with insurance through ObamaCare's marketplaces are satisfied with their plans.

That compares with 42 percent satisfaction from people with employer-sponsored plans, 48 percent with Medicaid and 58 percent with Medicare.

Cost is the most common reason cited for the dissatisfaction with ObamaCare. Republicans have attacked the high deductibles and other out-of-pocket expenses under the system.

An analysis from the consulting firm HealthPocket found that last year the average deductible for a silver-level ObamaCare plan was $2,907, more than twice as much as the average deductible in an employer-sponsored plan...

Poll: ObamaCare enrollees less satisfied with insurance plans | TheHill

allnurses Guide · Aug 4, 2015

Obamacare: 70 percent of previously uninsured Californians now have health plans

Nearly 70 percent of California's previously uninsured adults have gained health insurance coverage under the Affordable Care Act -- and most of them say their health care needs are being met, according to the latest survey of the Kaiser Family Foundation.

But the survey released Thursday by the Menlo Park-based group also found that plenty of challenges for the newly insured remain when it comes to paying for and accessing care. That applies both to those enrolled in plans through Covered California, the state's health insurance exchange established under the Affordable Care Act, and Medi-Cal, the state's program for the low-income and disabled that was greatly expanded under the health care law...

Obamacare: 70 percent of previously uninsured Californians now have health plans - San Jose Mercury News