Supreme Court to Hear Obamacare Suit

[maxparrish]

It clearly says state multiple times, in context, with appropriate section references.

Case closed.

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What's so controversial about this case? The authors of the law are still alive. There are documents and notes and early drafts available that shed light on the process. It should be possible to simply ask whoever wrote it if the law was meant to mean a "state" or not. If it can be shown that this was not the intent, then the use of the word "state" would be like misspelling a word or forgetting a comma and should be ignored. If they did mean it, then that's what it means.

Case closed?

Because they don't want to ask the writer of the law because his input will reveal this case as a sham. Correct me if I am wrong, but this case hinges on a cherry picked statement taken out of context.(He has spoken but somehow it hasn't stopped the case from going forward.)

Who is "the writer of the law"?

Oh Dismal, I think its time to give up and join the other side. Don't you recall the gazillion times that we have been told by the forum left that Obamacare was actually a Republican plan? Let's ask those Republicans, no?

 

[Horatio Parker]

The biggest unsupported assertion circulating here is that the authors did not intend the relevant subsidies.

Ignoring for the moment the fact your claim about what was intended is baseless, in a legal case of statutory interpretation the first way intent is established is by reading what the law says. The law clearly, unambiguously authorizes the credit on state exchanges only. Your emotionalized claims about the general intent do not trump the specific language of the law.

Ignore for a moment? You've ignored it all along, and have no grounds to call it baseless. You have no alternative because if that intent is considered, there is no case.

Besides, your narrow statutory interpretation is subjective.

Note: there is a reason for the hyperbole. If the language is judged ambiguous, the govt is allowed to interpret it. Therefore, the witch hunters have to take the position that the language unambiguously forbids federal exchanges.

 

[Horatio Parker]

What's so controversial about this case? The authors of the law are still alive. There are documents and notes and early drafts available that shed light on the process. It should be possible to simply ask whoever wrote it if the law was meant to mean a "state" or not. If it can be shown that this was not the intent, then the use of the word "state" would be like misspelling a word or forgetting a comma and should be ignored. If they did mean it, then that's what it means.

Case closed?

What the neocons want is to 1) use only the language of the law, and 2) interpret the language in such a way that subsidies through the federal exchange would be forbidden. That would hamstring ACA.

 

[Loren Pechtel]

Oh Dismal, I think its time to give up and join the other side. Don't you recall the gazillion times that we have been told by the forum left that Obamacare was actually a Republican plan? Let's ask those Republicans, no?

It's a Republican plan but the part in question obviously can't have been part of the original.

 

[maxparrish]

What's so controversial about this case? The authors of the law are still alive. There are documents and notes and early drafts available that shed light on the process. It should be possible to simply ask whoever wrote it if the law was meant to mean a "state" or not. If it can be shown that this was not the intent, then the use of the word "state" would be like misspelling a word or forgetting a comma and should be ignored. If they did mean it, then that's what it means.

Case closed?

The problem is that apart from the wording and structure of the law, the notion that their is a single intent or understanding by those who wrote, amended, and passed it is highly problematical. Anyone reviewing the history will see an over-reaching legislative mess (not unlike another 'grand plan' in the financial reform legislation). While the plan had a general idea behind it, as advanced by Gruber, it also has origins in prior failed proposals (e.g. Kennedy's plan), horse-trading, revisions by staffers, etc. The legislation was supposed to be heavily revised during reconciliation between the House and Senate, but it was rushed into passage and signed.

Now that its flaws are glaring, there are a few folks who "claim" they had a different intent, but most of it smacks as 20-20 hindsight and partisan rationalization. Even Gruber, who claimed that its intent was to provide the same benefits for federal exchanges, has been recorded in presentations to the public to sell ACA, explicitly stating that federal exchanges would NOT provide those benefits. (Heck, the bill did not even fund the federal exchanges).

So the bottom line is the law means what it says, and says what it means. If Congress and its "authors" want to change it in light of current realities, then they need to write amendments and pass them.

I know ACA supporters are angry that a Democracy sometimes requires an exercise of some kind of 'demoncracy', but in spite of Obama's assumptions, we are not a monarchy (not yet).

 

[dismal]

Ignoring for the moment the fact your claim about what was intended is baseless, in a legal case of statutory interpretation the first way intent is established is by reading what the law says. The law clearly, unambiguously authorizes the credit on state exchanges only. Your emotionalized claims about the general intent do not trump the specific language of the law.

Ignore for a moment? You've ignored it all along, and have no grounds to call it baseless.

It's baseless because you have offered nothing, nil, nada, zippo in support of it. No evidence.

When I say the law provides for tax credits in State exchanges I can cite what the law actually says as evidence.

My position: supported.
Your position: baseless assertion.

- - - Updated - - -

What's so controversial about this case? The authors of the law are still alive. There are documents and notes and early drafts available that shed light on the process. It should be possible to simply ask whoever wrote it if the law was meant to mean a "state" or not. If it can be shown that this was not the intent, then the use of the word "state" would be like misspelling a word or forgetting a comma and should be ignored. If they did mean it, then that's what it means.

Case closed?

What the neocons want is to 1) use only the language of the law, and 2) interpret the language in such a way that subsidies through the federal exchange would be forbidden. That would hamstring ACA.

Jeez, you could at least acquaint yourself with the basic argument before posting.

The law does in fact authorize credits on state exchanges only.

 

[Jimmy Higgins]

So why haven't Republicans gone after RomneyCare? The premise is the same.

Because they do not and never will have majority in the Massachusetts Legislature.

I'm talking about in Court.

 

[dismal]

Because they do not and never will have majority in the Massachusetts Legislature.

I'm talking about in Court.

I don't think Romney care makes any differentiation between state and federal exchanges so it would seem unlikely a case like this would arise.

 

[Jarhyn]

So, I see a lot of chest banging over the intent of the text. The way you clarify text is not to immediately interpret it in exactly the way that best benefits your desire of the world. The way you clarify such things is YOU ASK THE GUY THAT WROTE IT. Period. End of discussion. It's not like the constitution, 230 years later. They're still alive and lucid! Just fucking ask for clarification!

 

[dismal]

So, I see a lot of chest banging over the intent of the text. The way you clarify text is not to immediately interpret it in exactly the way that best benefits your desire of the world. The way you clarify such things is YOU ASK THE GUY THAT WROTE IT. Period. End of discussion. It's not like the constitution, 230 years later. They're still alive and lucid! Just fucking ask for clarification!

No one person writes laws. They are products of committees and such.

The law is clear. It authorizes the credit on state exchanges only. In cases where the law is clear we do not go back and ask people if they meant something different than what the law says and use their opinion. The law that passes is the law.

 

[ksen]

I am glad that my good friends dismal and max and their friends are experiencing stratospheric heights of orgiastic joy at the prospect of making health insurance unaffordable for millions and millions of americans again. They deserve to have some happy days in their lives.

And I agree with them that this law is shit and that we should just go to a real UHC system.

 

[Jimmy Higgins]

I'm talking about in Court.

I don't think Romney care makes any differentiation between state and federal exchanges so it would seem unlikely a case like this would arise.

So there is nothing objectionable in RomneyCare to go to court over?

 

[ksen]

http://www.hhs.gov/healthcare/rights/law/patient-protection.pdf

Sec. 1401(b)(2)(A):

the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act,

So the plaintiff's case is that federally run state exchanges don't meet the definition under 1311. Let's look at 1311(b):

(b) AMERICAN HEALTH BENEFIT EXCHANGES.—

(1) IN GENERAL.—Each State shall, not later than January 1, 2014, establish an American Health Benefit Exchange (referred to in this title as an ‘‘Exchange’’) for the State that—

(A) facilitates the purchase of qualified health plans;

(B) provides for the establishment of a Small Business Health Options Program (in this title referred to as a ‘‘SHOP Exchange’’) that is designed to assist qualified employers in the State who are small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market in the State; and

(C) meets the requirements of subsection (d).

Seems simple enough so far: tax subsidies are for Exchanges that are 1311 Exchanges as defined in Sec. 1311(b).

The federally run exchanges are defined in Sec 1321(c)(1):

(c) FAILURE TO ESTABLISH EXCHANGE OR IMPLEMENT REQUIREMENTS.—

(1) IN GENERAL.—If—

(A) a State is not an electing State under subsection (b); or

(B) the Secretary determines, on or before January 1, 2013, that an electing State—

(i) will not have any required Exchange operational by January 1, 2014; or

(ii) has not taken the actions the Secretary determines necessary to implement—

(I) the other requirements set forth in the standards under subsection (a); or

(II) the requirements set forth in subtitles A and C and the amendments made by such subtitles; the Secretary shall (directly or through agreement with a not-for-profit entity) establish and operate such Exchange within the State and the Secretary shall take such actions as are necessary to implement such other requirements.

Now, the Textualists tell us it's very important take the literal meaning of the words in the law in order to properly interpret it.

Section 1401 says subsidies are eligible on the Exchanges established under Sec 1311. Note that the word Exchanges is capitalized. That means there is a specific definition for what Exchanges are.

Section 1311(b)(1) gives us that definition:

an American Health Benefit Exchange (referred to in this title as an ‘‘Exchange’’)

Therefore an Exchange is that which meets the criteria drawn up in Section 1311.

Section 1321 directs the head of HHS to set up "such Exchange" for a State if a State does not set up a 1311 Exchange on its own. The text says "such Exchange". So unless the supporters of the Plaintiffs can demonstrate there's a different definition of the word "Exchange" in the text of the PPACA then that has to mean that "such Exchanges" set up by the federal government meet the requirements of 1311 Exchanges and thus individuals enrolling in those "such Exchanges" are eligible for the federal subsidies.

I lifted the above reasoning from here where you can go and read that author's development of this point.

 

[dismal]

I don't think Romney care makes any differentiation between state and federal exchanges so it would seem unlikely a case like this would arise.

So there is nothing objectionable in RomneyCare to go to court over?

I doubt there is a credits on state vs federal exchange issue.

 

[dismal]

http://www.hhs.gov/healthcare/rights/law/patient-protection.pdf

Sec. 1401(b)(2)(A):



So the plaintiff's case is that federally run state exchanges don't meet the definition under 1311. Let's look at 1311(b):

(b) AMERICAN HEALTH BENEFIT EXCHANGES.—

(1) IN GENERAL.—Each State shall, not later than January 1, 2014, establish an American Health Benefit Exchange (referred to in this title as an ‘‘Exchange’’) for the State that—

(A) facilitates the purchase of qualified health plans;

(B) provides for the establishment of a Small Business Health Options Program (in this title referred to as a ‘‘SHOP Exchange’’) that is designed to assist qualified employers in the State who are small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market in the State; and

(C) meets the requirements of subsection (d).

Seems simple enough so far: tax subsidies are for Exchanges that are 1311 Exchanges as defined in Sec. 1311(b).

The federally run exchanges are defined in Sec 1321(c)(1):

(c) FAILURE TO ESTABLISH EXCHANGE OR IMPLEMENT REQUIREMENTS.—

(1) IN GENERAL.—If—

(A) a State is not an electing State under subsection (b); or

(B) the Secretary determines, on or before January 1, 2013, that an electing State—

(i) will not have any required Exchange operational by January 1, 2014; or

(ii) has not taken the actions the Secretary determines necessary to implement—

(I) the other requirements set forth in the standards under subsection (a); or

(II) the requirements set forth in subtitles A and C and the amendments made by such subtitles; the Secretary shall (directly or through agreement with a not-for-profit entity) establish and operate such Exchange within the State and the Secretary shall take such actions as are necessary to implement such other requirements.

Now, the Textualists tell us it's very important take the literal meaning of the words in the law in order to properly interpret it.

Section 1401 says subsidies are eligible on the Exchanges established under Sec 1311. Note that the word Exchanges is capitalized. That means there is a specific definition for what Exchanges are.

Section 1311(b)(1) gives us that definition:

an American Health Benefit Exchange (referred to in this title as an ‘‘Exchange’’)

Therefore an Exchange is that which meets the criteria drawn up in Section 1311.

Section 1321 directs the head of HHS to set up "such Exchange" for a State if a State does not set up a 1311 Exchange on its own. The text says "such Exchange". So unless the supporters of the Plaintiffs can demonstrate there's a different definition of the word "Exchange" in the text of the PPACA then that has to mean that "such Exchanges" set up by the federal government meet the requirements of 1311 Exchanges and thus individuals enrolling in those "such Exchanges" are eligible for the federal subsidies.

I lifted the above reasoning from here where you can go and read that author's development of this point.

Wow, that's a lot of typing. Too bad it's complete garbage.

The law authorizes credits on an "Exchange established by the State under 1311". None of your bizarre mangling of language and logic transforms an exchange established by the feds under 1321 into an "Exchange established by the State under 1311" .

 

[ksen]

Unless you can come up with a statutorily different definition for "Exchange" then you are engaging in just so much handwaving.

Also Scalia, Thomas and Alito apparently disagree with you. (from here)

In their 2012 joint dissent in NFIB v. Sebelius, Justices Scalia, Kennedy, Thomas, and Alito read these parts as making no logical sense without one another and also read the statute to include subsidies on federal exchanges:

“Congress provided a backup scheme; if a State declines to participate in the operation of an exchange, the Federal Government will step in and operate an exchange in that State.”

and then:

“That system of incentives collapses if the federal subsidies are invalidated. Without the federal subsidies, individuals would lose the main incentive to purchase insurance inside the exchanges, and some insurers may be unwilling to offer insurance inside of exchanges. With fewer buyers and even fewer sellers, the exchanges would not operate as Congress intended and may not operate at all.”

 

[dismal]

Unless you can come up with a statutorily different definition for "Exchange" then you are engaging in just so much handwaving.

An exchange estabilshed by the Feds may well be an "Exchange" under the law, but it is not an Exchange established by the State under section 1311.

Notice there are extra words.

 

[Sabine Grant]

By Max: I know ACA supporters are angry that a Democracy sometimes requires an exercise of some kind of 'demoncracy', but in spite of Obama's assumptions, we are not a monarchy (not yet).

Actually, I have yet to encounter anyone who "supports the ACA" from any angle of considering it an ideal system. The support to the AHCA is based on an improvement versus what was a stagnating situation affecting millions of Americans (many being medically needy) who , prior to the AHCA, were either stuck remaining under insured or/and non insured. It is not anger regarding " a Democracy sometimes requires an exercise of some kind of democracy", it is anger about how this leading First World Nation would reverse back to a health care system which had exhibited the trait of restricting access to health care, to include the access to health care care for millions of medically needy folks.

I will give you straight forward what makes me "angry" :

-the elimination of subsidies in all 36 States (which includes my state of residency, Florida) would affect me directly. Directly as in being, once more, a medically needy person unable to afford and access the benefits an insurance plan covering the cost of VITAL treatments necessary to support my extended survival. I benefit of an excellent prognosis but only if and when I can have access to oncology based treatments each time my lymphoma recurs.

- I will content that I am certainly not an isolated case of a medically person. Further, as I am a health care worker, I am fully aware of Americans who had to ration themselves and delay a medical intervention which would have prevented the need for emergent care at a point when their condition reached an acute stage and one where the outcome was either fatal or necessitating much higher cost treatments. When it comes to catastrophic illnesses, the earlier they are detected and treated, the better the outcome and lower cost.

- The poor delivery of preventative medicine : again, under insured and non insured being the individuals most susceptible to abstain from regular physicals and tests designed to detect any predisposition to a condition developing in later age or even detect in early stages a condition which can be easily and successfully treated in early stages versus a poor prognosis in late stages and requiring much more extensive and lengthy treatments which of course will increase the cost.

-Hospitals ERs being,once more, confused for treatments centers addressing chronic conditions when they were exclusively designed to provide emergent/urgent care. Once more, under insured and non insured individuals, relying on ERs to address conditions which would otherwise be addressed and treated via a PCP or specialist.

-Accumulation of medical debts by under insured and non insured medically needy individuals. Even though current ACHA exchange plans still have high deductibles and cost out of pocket via substantial co pays, it is still an improvement over a total cost out of pocket for previously under insured and non insured. As a result, some health care providers are willing to set up a repayment plan via their own billing/financial dept because the due amount by the patient as part of their co pay is far more attainable over the course of monthly payments laid out over 2 years than if an amount reflecting tens of thousands of dollars. The largest oncology/hematology provider in Florida (80 centers, Florida Cancer Specialists and Research Center) has endorsed such repayment plan system which of course, they do not charge interest.

As a previously under insured household, in 2010 we had to assume the entire cost out of pocket of a surgical intervention, related biopsy, imaging tests and other tests addressing a recurrence of lymphoma because our Group Plan declined paying any share of the total cost. End result being us maxing out 2 credits cards and of course paying interests while we are still making payments in 2014. To add, more medical debts last year, when we had to assume total cost out of pocket for the use of an ambulatory surgical facility (outpatient), fees of 2000 dollars per eye. Considering that cataract surgery implies BOTH eyes, 4000 dollars were added to one of our Credit Cards debts.

Comparing with the benefits provided under our current ACHA exchanges provided insurance plan :

1) Cost of the pharma protocol Rituxan prescribed by my oncologist is covered 100% under RX plan. In 2010, we bypassed even one round of Rituxan because there was no way we could have afforded it out of pocket. Meaning we took a serious risk. To be noted that my current recurrence is located in the same group of inguinal nodes, detected in 2010. The usual protocol would have been to follow the surgical removal of the affected lymph nodes with at least one round of Rituxan. Though the actual protocol endorsed by the Board of Oncology is 2 years, 4 weeks of infusions every 6 months.

2) PCP and specialists visits amount to 1/4 for co pay from what I was expected to pay under our previous employer provided Group Plan from 2009 to January 1st 2014. And a Group Plan which was the ONLY access we had to insurance in view of my diagnosis established in 2005. While the employee share of the premium was 560 dollars monthly for that "crumbs" Group Plan from 2009 and on.

3) Imaging tests ,which in my case, necessitate a PET/CT Scan measuring the metabolic activity in all lymph nodes : current plan benefits covering 80% of the cost versus NONE in the previous employer provided "crumbs" Group Plan. Similar coverage for blood panels, CBCs etc...And considering that those blood tests and imaging tests are an absolute necessity while I undergo Rituxan treatments, needless to say that I would be accumulating a huge amount of medical debts if the total cost were to be out of pocket.

The up to date figure(from last week) provided by our insurance company regarding how much we "saved" under our current ACHA Exchange Plan is a few dollars short of 70.000 dollars. Were we still stuck with our previous "crumbs" Group Plan, I estimated that we would have accumulated 64.000 dollars of medical debts from out of pocket cost between January 2014 and now. That is granted we could have figured out a way to pay such a high amount. Which we would not have been able to.

Let me introduce you to the catastrophic consequences not just for me but other millions of medically needy persons unable to access indispensable treatments and medical procedures :

To put it bluntly and connected to existing realities, the outcome for me would have been to wake up each day with the knowledge that I had no access to VITAL treatments. That my type of lymphoma remaining untreated would progress to numerous tumors affecting all lymph nodes to include those located by vital organs. That I was to contemplate the reality of a lengthy process of agonizing death. My fight against my cancer would not have been lost because it is not a treatable form of blood cancer and the outcome is always fatal, but because my access to an adequate insurance plan would have been obstructed. To note that if when I was diagnosed in 2005, the life expectancy for my type of lymphoma was only 9 to 12 years, thanks to the advance and progress in pharma research, it is now 20 years or more granted it can be treated each time it re surges. Statistics continue to improve, reflecting a positive and successful response to monoclonal treatments prompting remission. If incurable, it is easily treatable.

Breast cancer is not any longer the killer it used to be. Between the continuous progress in pharma research and genetic based research, the field of oncology has been able to not only treat BC successfully but also prevent it in women identified at high risk to develop it. However access to such specialized care was restricted and limited prior to the AHCA, for under insured and non insured categories.

The above of course does not fit your depicting of those who "support the ACA". Since you seem to think their anger is motivated by the reasons you developed on. It was necessary for me to introduce you to the reasons why some of us are "angry". I am not even sure that if anger is what I am experiencing in view of the repeated attempts to repeal or find a crack to repeal the ACHA. It is more like a return to fear and profound sadness. The sense of safety and security I have experienced since January 1st 2014 is now compromised by an added "Damocles Sword". As if cancer diagnosed persons and other disastrous illnesses are to be subjected to an added Damocles Sword over their heads. The diagnosis alone being the hell of a Damocles sword.

 

[ksen]

Unless you can come up with a statutorily different definition for "Exchange" then you are engaging in just so much handwaving.

An exchange estabilshed by the Feds may well be an "Exchange" under the law, but it is not an Exchange established by the State under section 1311.

Notice there are extra words.

Maybe you're not aware of this but capitalized terms in legislation are also defined in that legislation. So merely claiming that "such Exchange" means some heretofore undefined "Exchange" is just so much wishful thinking.

If "such Exchange" does not refer back to the previously defined "Exchange" then the term "such Exchange" is meaningless.

 

[Sabine Grant]

I need to affirm another reality as debates occurring in this Forum always come down to labeling opposing posters to being motivated by a political partisan mentality : mine is NOT. Mine is based on what is humanely acceptable and what is not. It is my humane based experience which makes me cringe and fear each time the GOP attempts to find any justification to impair my access (as well as other millions of human beings' access) to affordable and adequate insurance plans. It is the indifference you, Dismal and Max, show towards those fellow human beings while neither you Dismal, nor Max, nor the GOP have so far presented any viable alternative to the AHCA, for people like me and other millions.

You write us off while pausing as defenders of this "democratic" Republic, oh so endowed with righteousness and such strong sense of correctness. Meanwhile, you write us all off. You want to applaud and cheer for the dismantlement of subsidies and tax credits in 36 States? You'd better be prepared to present a viable alternative promoted and supported by a now GOP majority in your Congress.

And I placed "democratic" in quotes because for some of us, we do not define this nation as an actual democracy in view of your corrupted electoral system.