Average Joe SCOTUS: Maine Community Health Options v. United States

So, we all remember this monstrosity, the Affordable Care Act, also known colloquially as Obamacare, right?

Well, one of the piece of shit parts of this piece of shit law, was a Risk Corridor provision they added to insure the previously uninsurable. Listen to this bullshit. Are you ready?

They told insurance companies to insure these people, and they would reimburse them if they incurred losses. And they would get the money to reimburse them from companies who were making higher profits and not incurring such losses.

This was a scheme brought about because the government wanted all people insured, but the insurance companies rightly argued that these people who were previously deemed uninsurable have no data for us insuring them previously, for us to figure out a fair rate that covers them.

So the government basically told them, “do your best” on figuring out a rate, and if you lose money, we’ll reimburse you.

The plan was to give them three years to figure out a proper rate during this period, then the risk corridors would go away.

Here’s the rub. These idiots literally thought somehow that insurance companies would make as many profits to cover the losses from insuring people with pre-existing conditions, and other life-long medical needs. Because apparently, not one of these 538 assholes ever took a fucking math class.

Anyway, the insurance companies did what they were told, but then as usual, Congress was full of shit, and denied paying such claims, because “Surprise!” they didn’t recoup enough profits from other insurance companies to cover all these crazy high claims.

So now Maine Community Health Options (MCHO) is suing the Fed for what they’re owed, or the repeal of this stupid fucking law. May a god I don’t believe in be with them.

SCOTUS’ job is determine if the law passes constitutional muster since the government isn’t fulfilling their obligation, but yet expect these insurance companies to comply nonetheless, basically putting them in an untenable position.

At one point, Justice Roberts seemed to clearly grasp the idea that the government’s argument was a load of shit.

John G. Roberts, Jr.

I vaguely recall the government arguing on several occasions that unenacted bills are entitled to some weight in the interpretation process, but you don’t question that these insurance companies would not have participated in the risk corridor program but for the government’s promise to pay?

Edwin S. Kneedler

I — I don’t — well, it’s not about participating in the risk corridor program.

The question is they participated in the — in the marketplaces that were set up, the exchanges, and they had a number of business incentives.

This was a vast new market for customers, many of whom, 90 percent of whom would get tax subsidies.

John G. Roberts, Jr.

— customers who otherwise were largely uninsurable.

Edwin S. Kneedler


But they — but it was a mark —

John G. Roberts, Jr.

Well, that’s no great business opportunity for them.

Edwin S. Kneedler

Oh — oh, no, it — it is, because Congress provided tax credits to subsidize the — the — the persons who — who purchased insurance on the exchanges.

John G. Roberts, Jr.

No, it’s a good business opportunity for them because the government promised to pay.

If you’re wondering what the state’s argument in all this is, as near as I can tell, they’re saying that the duty to pay was contingent on a “subject to appropriations” clause. Meaning that in the law, it basically argues they’ll pay if any future congress of the time agrees to appropriate the funds.

So get this straight.

Government MANDATED private insurance companies do something on a promise to pay them later. But then congress said, “well, we’ll pay if we agree to, anyway.”

What the fuck is that?

Even Elena Kagan, who is often deemed a more left-leaning justice seemed to think it was ridiculous.

Elena Kagan

Mr. Kneedler—are insurers obligated to pay in if they have excess profits?

Edwin S. Kneedler

Yes, it is a user fee.

Elena Kagan

So this is one where the “shall pay in” is obligatory but the “shall pay out” on the part of the government is not obligatory?

Edwin S. Kneedler

The  pay in is not subject to an appropriations question.

It is an obligation.

And that part of the arrangement, the reciprocity in the program still exists, the payments in and payments out, which is how I think most —

Elena Kagan

I mean, you pay in, that’s obligatory.

We commit ourselves to paying out.

It turns out if we feel like it. What — what kind of — what kind of a statute is that?

In an 8-1 decision, SCOTUS agreed with Maine Community Health Options. The government has to pay these insurance carriers the money they fucking owe them. And by government, it means you and I, the taxpayer, in case you weren’t aware.

Alito, the only dissenter argued that the majority’s opinion “infers a private right of action”, but that wasn’t in the law created by congress. I believe he may be on crack.

Drop some genius on me here.

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