Thursday, May 31, 2012

Late pleadings for the ACA

For those who, like a besotted lover whose beloved's day to wed another fast approacheth, can't stop piling up arguments in favor of the constitutionality and necessity of the Affordable Care Act, a few eloquent doomed love notes:

1. Healthy twentysomething Mormon missionary can't buy coverage:
I hit the quarter-century mark on the eve of two adventures -- an LDS mission and life without health insurance.

Although the LDS Church covers basic health care for its missionaries, I was hesitant to spend 18 months without health insurance.

As a health reporter, I'd seen the devastating effects of being uninsured. As the child of a man who won the insurance lottery (thank you, three years of cancer) I knew how important it was.

Fortunately, I had enough money in savings to pay the premiums for catastrophic health coverage. I should note that I'm a gold mine for health insurers -- I go to the doctor on average once a year. My biggest emergency, if you could call it that, was when I cut my leg open at age 12 and required stitches and a tetanus shot. Basically, I'm giving the insurance company my bank account and getting nothing more than an unused safety net.

Except they said no. Some years ago, I slightly strained a knee while hiking. At worst it was an annoyance; I didn't limp or have to stay off of it. I took a short break from running only because my doctor told me to.

As pre-existing conditions go, you can't get much tamer. But the sore knee existed, or at least it had sometime in the foggy past, and that was enough to give me a black eye in front of the insurance company.
The rest is a modest proposal to an arch-conservative community. Do read.

2. While many can't buy any kind of coverage in the individual market, those who do find a plan quite often are forced to buy subpar coverage.  Employee Benefits News reports on a Commonwealth Fund study:
More than half of Americans with individual market health insurance coverage in 2010 were enrolled in so-called "tin" plans, which provide less coverage than the lowest "bronze"-level plans in the Affordable Care Act, and therefore would not be able to be offered in the health insurance exchanges that are being created under the law, according to a Commonwealth Fund. The analysis suggests that once the state-based exchanges — set up to make it easier for individuals and small businesses to shop for health insurance — go into effect in 2014, many of these Americans will be able to purchase plans that offer better coverage. In addition, many will be eligible for premium subsidies that will help offset the cost of the plans.
A pity that the conservative Supreme Court justices seemed more taken with the fanciful notion that the ACA would force hoards of healthy young adults to buy more coverage than they need than with the fact that those who can't get coverage from their employers generally are currently forced (to borrow the plaintiffs' favorite verb) to buy subpar coverage if they can find any plan at all. In the same vein, see the amicus brief in defense of the ACA by the Young Invincibles, a coalition of 20 youth groups, which documented the extent to which young Americans want, need and lack adequate health insurance [this item added as an update, 8:00 p.m.].

3. Legal scholar Andrew Koppelman traces the short happy life of constitutional objections to the mandate (hint: those objections are way younger than GOP advocacy for a mandate). Originally a virgin birth from Randy Barnett's fevered brain, it multiplied like rabbits once a notorious Fox got hold of it. Hat tip for this one to the estimable Ragbatz tumblr.

4.On Balkinization, Rob Weiner writes: "To a remarkable degree, the challenges to the Affordable Care Act reflect an effort to codify legal nostalgia as legal doctrine" -- that is, to resurrect restrictive views of Congress's power to regulate commerce that have been superseded for 75 years and more (scroll down to May 30 -- there don't seem to be URLs for individual posts).

5. Jill Horwitz and Helen Levy of U. Mich. explode the bogus economic arguments underpinning the case against the mandate -- e.g., that it would be analogous for Congress to compel purchase of broccoli, cars or burial insurance, and that the young are being conscripted to finance coverage for the older uninsured (xpostfactoid gilds the lily here).

6. Consider this a preemptive strike against nemesis. King Lear, Act V. iii. 259: Howl, howl, howl, howl.

7. But wait: This feather stirs; she lives. 

More on catastrophic coverage in the ACA and misrepresentation of the mandate in the Supreme Court

On the mandate more broadly
The individual mandate is a piece of Cake (4/25)
Verrilli's limiting principles (4/24)
If only Verrilli had said (A, B, C) (3/31)
Verrilli, slapped silly, recovers willy-nilly (3/28)
External links
Patient cost-sharing under the Affordable Care Act (Kaiser Family Foundation. 4/27)
Will the justices make a catastrophic error? (Jonathan Cohn, 4/19)
Policy ignorance at the Supreme Court (Steve Benen, Maddow blog, 4/16)
Supreme Court misunderstanding on health overhaul? (AP's Ricardo Alonso-Salvidar, 4/10)
The bounded, minimalist way to uphold the ACA (Marty Lederman at Balkinization, 4/2) 
Ragbatz on the catastrophic coverage options in the ACA - a healthcare attorney picks up the plaintiff's con in real time ( 3/28)

No comments:

Post a Comment