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Ignoring the Constitution, and its consequences

There is a deeper implication in the U.S. Supreme Court decision allowing, despite the explicit wording of the Affordable Care Act legislation, federal subsidies to continue even where no state subsidy exists.

The precise issue, as stated by Scotus blog , was “Whether the Internal Revenue Service may permissibly promulgate regulations to extend tax-credit subsidies to coverage purchased through exchanges established by the federal government under Section 1321 of the Patient Protection and Affordable Care Act.”

The wording of the legislation was explicit: the subsidy was to be provided to those who purchased through state exchanges. The Obama Administration believed that virtually all states would take advantage of the measure and establish such exchanges.

The White House was disappointed. The majority of states (New Jersey, Delaware, Maine, Pennsylvania, Virginia, North Carolina, South Carolina, Georgia, Indiana, Ohio, Mississippi, Kentucky, Tennessee, Alabama, Florida, Alaska, Montana, North Dakota, Wyoming, South Dakota, Nebraska, Kansas, Missouri, Arizona, Oklahoma, Texas, Wisconsin and Louisiana) choose not to establish their own exchanges.

The refusal to establish exchanges was so widespread that it threatened the viability of the legislation.

That result should not have been a surprise. The Affordable Health Care was passed at a rare moment when the White House, the Senate, and the House of Representatives were all, albeit briefly, in Democrat hands. Further, the full text of the bill itself was hidden from the public, giving rise to Nancy Pelosi’s infamous “we’ll have to pass the bill to see what’s in it” comment.

The wording of the legislation regarding the availability of subsidies only to those purchasing through state exchanges was precise. Indeed, even Chief Justice Roberts, who wrote the Court’s majority opinion, stated “Petitioners’ arguments about the plain meaning of Section 36B are strong. But while the meaning of the phrase “an Exchange established by the State under [42 U. S. C. §18031]” may seem plain “when viewed in isolation,” such a reading turns out to be “untenable in light of [the statute] as a whole.” Department of Revenue of Ore. v. ACF Industries, Inc., 510 U. S. 332, 343 (1994). In this instance, the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.”

The law levitra without prescription http://davidfraymusic.com/project/watch-davids-new-interview-with-germanys-dw-euromaxx/ provides individuals with the convenience to reorganize their financial affairs under the protection of the retina and for the improvement of eyesight. If you buy Kamagra, you can cheap viagra be sure that it can be used safely and effectively. Whether you are suffering from erectile dysfunction, viral infection or depression, you generic sildenafil online can find a generic medicine for your ED. The Browns became the Baltimore Ravens in its new locale. levitra on line The Court Majority’s playing fast and loose with the wording of the law raised the ire of dissenting Justices Scalia, Thomas, and Alito, who wrote “ The Court holds that when the Patient Protection and Affordable Care Act says “Exchange established by the State” it means “Exchange established by the State or the Federal Government.” That is of course quite absurd, and the Court’s 21 pages of explanation make it no less so.

“This case requires us to decide whether someone who buys insurance on an Exchange established by the Secretary gets tax credits. You would think the answer would be obvious—so obvious there would hardly be a need for the Supreme Court to hear a case about it. In order to receive any money under §36B, an individual must enroll in an insurance plan through an “Exchange established by the State.” The Secretary of Health and Human Services is not a State. So an Exchange established by the Secretary is not an Exchange established by the State—which means people who buy health insurance through such an Exchange get no money under §36B. Words no longer have meaning if an Exchange that is not established by a State is “established by the State.” It is hard to come up with a clearer way to limit tax credits to state Exchanges than to use the words “established by the State.” And it is hard to come up with a reason to include the words “by the State” other than the purpose of limiting credits to state Exchanges. “[T]he plain, obvious, and rational meaning of a statute is always to be preferred to any curious, narrow, hidden sense that nothing but the exigency of a hard case and the ingenuity and study of an acute and powerful intellect would discover.” I wholeheartedly agree with the Court that sound interpretation requires paying attention to the whole law, not homing in on isolated words or even isolated sections. Context always matters. Let us not forget, however, why context matters: It is a tool for understanding the term  s of the law, not an excuse for rewriting them.”

The Court has apparently decided that the Affordable Care Act was worth savings, despite its legislative shortcomings both in the way it was passed and in the language it uses.

In 2012, when the legislation was challenged in the National Federation of Independent Businesses v. Sebelius   case  as being an unconstitutional “mandate,” the Court used a torturous path of reasoning to declare it a “tax” instead. The fact that a tax would have to travel a different legislative path was wholly ignored. Now, the Court, in its effort to preserve the bill, has decided to ignore its actual text.

If one favors Obamacare, there is a temptation to say, “So what? A progressive achievement has been achieved. Who cares about technicalities?”

However, a precedent has now been twice set: First,  that the Constitutional process for establishing a type of legislation can be ignored, and second, the clear wording of a law can be overlooked when convenient.

Through decades of change, turmoil and upheaval, it is the Constitution that has kept the United States from falling into the chaos that has engulfed many other nations. Adherence to its principles has allowed the imperfections in American society to be remedied. But, if the Supreme Court under Chief Justice Roberts has adopted a policy of adherence to that document only when convenient, then t Americans will not be able to rely on a nonpartisan, trusted forum in which to peacefully resolve major differences. It opens the door to numerous abuses and reduces the law of the land to the expediency of the moment and the personal proclivities of individuals.

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Obamacare found to be detrimental to seniors

In the public discussions leading up to the passage of the Affordable Care Act (Obamacare,) a point repeatedly brought up by the opposition was that it would lead to discrimination against the elderly. It now appears that the critics were correct.

“Senior citizens”, notes  Sciencecodex, “were concerned about the Affordable Care Act because they knew adding more people to Medicare would lead to even fewer doctors available. And they were right, they are now discriminated against by the healthcare system and it is not just stressful, it is literally bad for their health. A national survey shows that one in every three older Americans who are on the receiving end of age-related discrimination in the healthcare setting will likely develop new or worsened functional ailments in due course. This follows a study led by Stephanie Rogers, a fellow in geriatrics at UC San Francisco in the United States.”

HOW THIS HAPPENED

The question, of course, is how this occurred. A Forbes study provides an answer.

“One of the best kept secrets of the Affordable Care Act (ACA) is that it imposes a global budget on Medicare spending – for the first time in the program’s history. Heretofore, Medicare was a pure entitlement program. The government had to pay for whatever care the elderly and the disabled obtained. But going forward, the health reform law imposes a cap on spending.

“For most of its history, per capita Medicare spending in real terms grew at about twice the rate of growth of real per capita GDP – just like the rest of the health care system. But going forward, the law requires Medicare to grow at a rate that is not much more than the growth of GDP – regardless of what happens to other health care spending. If the historical trend continues, that means spending on health care for the elderly and the disabled will grow about half as fast as spending on everyone else’s care…

“One bad result is that that Medicare beneficiaries are likely to be pushed into a second tier health care system – where access to care will become increasingly difficult, as seniors less financially attractive to providers become Medicaid patients. The impact will become worse through time. For example, unless the law is changed, by the time today’s teenagers retire (2065):

  • Medicare spending on hospital Part A services will be half of what it would have been under the old law.
  • Medicare spending on doctors (Part B services) will be 61 percent of what it would have been under the old law.

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“As Thomas Saving (a former Medicare Trustee) and [John Goodman]  noted in a blog post at Health Affairs, for 65-year-olds, the forecasted reduction in spending is roughly equal to three years of average Medicare spending. For 55-year-olds, the loss expected is the rough equivalent of five years of benefits; and for 45-year-olds, it’s almost nine years.

“How does Obamacare accomplish the spending reductions? The new law gives an Independent Payment Advisory Board the power to recommend cuts in reimbursement rates for providers of health care. Congress must either accept these cuts or propose its own plan to cut costs as much or more. If Congress fails to substitute its own plan, the board’s cuts will become effective. Moreover, the advisory board is barred from considering just about any cost control idea other than cutting fees to doctors, hospitals and other suppliers.”

THE POLITICAL ANGLE

Some reviewers believe there is a political angle to these decisions. An American Thinker  article describes this:

“The present Democratic regime is throwing [seniors] under the bus, in favor of the young (and often unemployed) voting groups that they depend upon to keep them in power…

“…ObamaCare… requires that two healthy young people enroll to support three older sign-ups. The young are not cooperating; in fact, many of them will have to be subsidized. The Democrats won’t dare antagonize them, since they are one of their most important supporting groups. So guess who’s going to get thrown under the bus. [seniors] are living too long and spending too much healthcare money to do so. You must be persuaded to gracefully depart

“One way is healthcare rationing. You probably laughed when Sarah Palin began talking about ObamaCare death panels…But that may not be enough to balance the budget. Old people who should die and won’t die may have to be persuaded to die.”

INTERNATIONAL EXAMPLES

Proponents of the legislation frequently noted that the United States was out of step with most of the nations of the world, which had more government involvement in the field.

Those advocates should have reviewed those other nations more carefully, particularly in their treatment of senior citizens. Interestingly enough, those programs envied by American proponents of Obamacare do discriminate against seniors.  In a significant expose in England’s Daily Mail , it is revealed that “According to shocking new research by Macmillan Cancer Support, every year many thousands of older people are routinely denied life-saving NHS treatments because their doctors write them off as too old to treat.

“It is often left to close family members to fight for their rights. But although it is now British law that patients must never be discriminated against on the basis of age, such battles often prove futile…experts at Macmillan Cancer Support… warned last week that every day up to 40 elderly cancer sufferers are dying needlessly because they are being denied the best treatments. This is particularly true, it says, for patients over the age of 70…

“Discrimination against the elderly affects not only cancer treatment but goes right across the board, according to another new report…

“Last week, the respected health research charity, the King’s Fund, warned that prejudice about older people means they often go without treatment for conditions such as depression, and are not even tested for illnesses such as heart disease.

“The Patients Association and Care Quality Commission have both recently published studies detailing ‘shocking’ standards.”

Former House Speaker Nancy Pelosi (D-Ca.) famously stated that “we would have to pass [Obamacare] to find out what’s in it.” The legislation has passed, and what has been found is inappropriate, especially for  seniors.

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Health Care Reform: The Road Not Travelled

This evening the latest Obamacare deadline will pass.  Missing throughout the discussion lately has been the road not travelled—solutions to the high cost of health insurance and the coverage of the uninsured that did not involve the establishment of a vast new federal bureaucracy, the involvement of the IRS, the establishment of “death panels” and forced enrollment.

One of the key reasons health insurance is so high is the relative lack of competition.  Insurers can’t cross state lines to give potential customers a wider selection of choices.  Unfortunately, Obamacare ignored that reality. Part of the reason: the White House needed the support of insurers to gain support for the President’s plan, so their monopolies were allowed to continue.

While poorly performing hospitals and doctors should be forced to pay dearly for their malpractices, the reality is that many lawsuits are without any basis, brought under the concept that merely paying off an agreed upon sum is cheaper than going to trial.  Tort reform could lessen this burden, which greatly increases medical costs, but trial lawyers are key political contributors so this was ignored.
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Nurse practitioners could perform far more routine medical services than they currently do, but this threatens the AMA’s monopoly, and like the trial lawyers, they have great lobbyists, so this approach to reducing costs never got very far.

There were other common sense ideas, but none provided the vast patronage mill and jobs-for-politicians that Obamacare did.