Tag Archives: affordable care act

Average Joe SCOTUS: California v. Texas

You all remember the days when the Affordable Care Act was challenged in SCOTUS, and Chief Justice Roberts argued that the penalty was a tax, and therefore constitutional, right?

Well since then, Republicans, unable to repeal Obamacare outright, made the penalty zero. So now that the penalty is zero, Republicans are now arguing it’s no longer a tax, and therefore the individual mandate is an unconstitutional mandate, and the law should be repealed entirely.

The ACA supporters will argue that the mandate is severable, meaning SCOTUS could remove the mandate clause and leave the rest of the law in tact. But Republicans are like, “That’s how the fucking law was paid for. So you can’t fucking sever it.”

So basically SCOTUS is being asked to re-review this case in light of this new change.

With regards to severing the law, Congress reduced the tax to zero, but didn’t repeal the law. If they had the power to do one, they had the power to do the other. So the argument is then made that it must be severable, because if congress wanted the law to be repealed, they’d have repealed it, not reduced the tax to zero.

But the argument to that, is that congress didn’t have the votes or support for a full repeal, but by removing the tax, they’re hoping SCOTUS will nullify it, effectively trying to make SCOTUS the “bad guy” in all this shit.

At one point, Justice Kavanaugh asked:

Brett M. Kavanaugh

Are you aware of any other examples in the U.S. Code at least where Congress has enacted a true mandate, not something hortatory, but a true mandate with no penalties?

Essentially questioning the validity of such a law knowing there’s no other instance where congress forces you to buy something. Social Security is forced retirement income, but you don’t go out and buy it, government just takes it as a tax.

The reason this is Texas v. California, is because Texas challenged the law, and California and other states are defending it.

In a 7:2 decision, where Alito and Gorsuch dissented, SCOTUS ruled in favor of California. Texas may not sue California over this bullshit. Texas hasn’t shown in any way how they were harmed by California and company, and therefore they have no grounds to be suing here.

Hear oral arguments and read about the case here.


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.

Why Pre-Existing Conditions Matter

Gary Nolan (and THE Scrappy Doo)
Gary Nolan (and THE Scrappy Doo)

In the Affordable Care Act, AKA Obamacare, there is a provision that requires health insurance companies cover pre-existing conditions. While the majority has condemned the insurance mandate of the ACA, most are in favor of pre-existing condition coverage being forced onto health insurers.ACA%20image[1]

However, I feel that this is unwitting hypocrisy. How can someone oppose the government forcing them to pay for something but be OK with the government forcing someone else to? We oppose the mandate because we empathize with those who feel they don’t need to buy health insurance right now. But with pre-existing conditions, we then imagine situations where we lose our job and insurance and then are unable to get coverage because of pre-existing conditions, and lose our wonderful powers of empathy we had a moment ago and decide “f*** the insurance companies.”

This is what happens when people don’t care where money is coming from or who the loss hurts, as long as it benefits them personally.

It seems cruel to people that insurance companies would deny pre-existing conditions, but quite frankly, it’s wrong for us to expect them to cover them. I’d like to think it is because people don’t fully understand the issues with this, so having an insurance background, I’ll try to explain.

Imagine you decide to trade in your car which happens to have a irreparably damaged engine—now only serving the function of an industrial-sized paperweight. The car should be worth $5,000, but it needs $3,000 worth of repairs. The dealer takes the car in on trade for $2,000, and then resells it without fixing the engine. Instead, they sell the new buyer a $1,000 warranty. The new owner takes the car to a repair shop to address the blown engine, submits the claim, and now the $1,000 policy is supposed to pay for a $3,000 engine repair everyone knew it needed before all of this started?

Engine Which Has Suffered a Connecting Rod Failure
Engine Which Has Suffered a Connecting Rod Failure

The insurance company would immediately take a $2,000 loss that it would have no way to recover since the policy was paid in full up front for $1,000. While the consumer and dealer might think this is awesome, the insurance company and all its employees who are about to go out of business because they’re repeatedly taking unrecoverable loss, won’t be as pleased.

The ultimate truth is that covering a pre-existing condition is not insurance, it’s a grant.

Insurance is designed so that the insured pays a premium up front, and in return, the insurer takes a financial risk that the insured can’t afford to take themselves. What’s the risk you ask?

Imagine you open a collision policy, and then pay your first premium of $200. On the way home from the agent’s office, you plow into someone and send them to the hospital with a quarter-million dollar medical bill. Guess what? The insurance company just lost $249,800 on you, and there is nothing to stop you from canceling your policy immediately after, leaving them with a massive loss. That’s a legitimate risk they take every single day.gap-insurance-1[1]

The way they make a profit is by employing actuaries who calculate the insurance company’s anticipated claims using mathematical models, then the insurer charges a percentage above that in hopes the actuaries are have nailed their projected losses. You the consumer benefit because you passed that risk of a $250,000 settlement you might have incurred and can’t afford onto the insurance company, in favor of a monthly payment you can afford.

Here’s the reason I say that covering pre-existing conditions is a grant. What is to stop you from dropping your insurance company after you’ve had a massive claim like that? The answer is nothing. In the accident situation I explained, it is the risk the insurance companies take. While they lost, risk is the business they are in after all.

But in the pre-existing condition situation, there is absolutely no risk. You already have the condition, and they are going to be expected to pay for it. The word risk implies they may or may not incur damages, but with pre-existing conditions, risk is replaced with certainty because now they are liable for something you knew existed—because it was PRE-EXISTING.

Imagine you owned an insurance company and someone drove up with their car on a tow truck smashed to bits, requesting to start a full coverage policy with you. Are you really going to agree to that deal knowing that the claimant is going to give you $200 only to file a $10,000 claim tomorrow? If you’re answer is yes, you may want to avoid starting your own company. So, using the “Golden Rule” as a standard, why are we doing unto them, what we wouldn’t want done unto us?gap-insurance-1[1]

I am not a heartless person who thinks people should be left to die. But, aside from the obvious personal responsibility issues of people who can buy insurance but opt not to, I believe we should not be treating insurance companies as if they’re Satan in business form, and that taking advantage of them should be considered an acceptable or even honorable practice. They employ a lot of people and help keep our economy strong by assuming those risks most of us can’t afford for a nominal fee we can. If you don’t like it, feel free to take that risk yourself if you can afford to.

Contrary to left-wing beliefs, insurance companies do not have a bottomless wallet. They can, and often do, go out of business if their losses become excessive, just like any other business. Which hurts all the people who work for them.

So while this law doesn’t pass the costs onto the taxpayer per se, insurance companies will pass it to the consumer in the form of raised rates, lest they go out of business. Many of you have no doubt noticed the rate increases already. And while we’re at it, taxpayer and consumer are generally the same people; it’s just the former implies the government pilfered a few bucks first.

There is a better way to improve the health care system through deregulation and tort reform which would lower costs. Taking advantage of legitimate businesses that are then forced to pass those damages onto us is not the answer.