physasst Posted March 27, 2012 Author Share Posted March 27, 2012 Day one of the PPACA being heard before SCOTUS is over. Both sides were grilled. Take home points: 1. The AIA (Anti-Injunction Act) is unlikely to apply here, and the Justices seemed unwilling to let that stop them from seeing the case. 2. The opponents of the ACA tried to argue that the mandate and the penalty were severable.....to which Chief Justice Roberts basically called BS, which should give the DOJ some hope. 3. Medicaid was brought up, and the attorneys for the 26 states opposing the bill tried to claim harm by increased Medicaid enrollment. To which the Justices asked about eligibility. It was then stated that Medicaid rolls would expand by increased enrollment with the mandate, but that the majority of that would be by people who are already ELIGIBLE for Medicaid but not enrolled....Mr Katsas: The very poor are the people Congress would be most concerned about with respect to the mandate, to the extent one of the justifications for the mandate is to prevent emergency room cost shifting when people receive uncompensated care. So they would have had very good reason to make the very poor subject to the mandate, and then they didn’t do it in a draconian way; they gave the very poor a means of complying with the insurance mandate, and that is through the Medicaid system. The Justices were not impressed....several expressed disbelief that the States could suffer harm by enrolling invididuals who they had already determined were eligible. Today is day #2, and they will start hearing on the mandate Link to comment Share on other sites More sharing options...
physasst Posted March 27, 2012 Share Posted March 27, 2012 Day one of the PPACA being heard before SCOTUS is over. Both sides were grilled. Take home points: 1. The AIA (Anti-Injunction Act) is unlikely to apply here, and the Justices seemed unwilling to let that stop them from seeing the case. 2. The opponents of the ACA tried to argue that the mandate and the penalty were severable.....to which Chief Justice Roberts basically called BS, which should give the DOJ some hope. 3. Medicaid was brought up, and the attorneys for the 26 states opposing the bill tried to claim harm by increased Medicaid enrollment. To which the Justices asked about eligibility. It was then stated that Medicaid rolls would expand by increased enrollment with the mandate, but that the majority of that would be by people who are already ELIGIBLE for Medicaid but not enrolled....Mr Katsas: The very poor are the people Congress would be most concerned about with respect to the mandate, to the extent one of the justifications for the mandate is to prevent emergency room cost shifting when people receive uncompensated care. So they would have had very good reason to make the very poor subject to the mandate, and then they didn’t do it in a draconian way; they gave the very poor a means of complying with the insurance mandate, and that is through the Medicaid system. The Justices were not impressed....several expressed disbelief that the States could suffer harm by enrolling invididuals who they had already determined were eligible. Today is day #2, and they will start hearing on the mandate Link to comment Share on other sites More sharing options...
physasst Posted March 27, 2012 Author Share Posted March 27, 2012 SCOTUS Day #2 Our USA TODAY colleague Richard Wolf sent us this missive on the second hour of today's arguments: During the second half of the two-hour session, however, Justice Anthony Kennedy and Chief Justice John Roberts sharply questioned lawyers for the 26 states and business consortium challenging the law, leaving it unclear which way the two justices are leaning. Kennedy said the uninsured constitute "an actuarial reality" that should be taken into consideration, even though they are not actively involved in commerce. Near the end of the session, he said health care and health insurance may be different from other economic markets in that "the young person who's uninsured" at least comes "close" to affecting the overall market. Roberts preceded most of his inquiries by noting the government's position that the health care market is unique because those without insurance raise costs for those with it, and that almost everyone eventually will need health care services. "Surely regulation includes the power to promote," the chief justice said. Looks like Kennedy and Roberts will be the swing votes. As predicted.... Link to comment Share on other sites More sharing options...
physasst Posted March 27, 2012 Author Share Posted March 27, 2012 SCOTUS Day #2 Our USA TODAY colleague Richard Wolf sent us this missive on the second hour of today's arguments: During the second half of the two-hour session, however, Justice Anthony Kennedy and Chief Justice John Roberts sharply questioned lawyers for the 26 states and business consortium challenging the law, leaving it unclear which way the two justices are leaning. Kennedy said the uninsured constitute "an actuarial reality" that should be taken into consideration, even though they are not actively involved in commerce. Near the end of the session, he said health care and health insurance may be different from other economic markets in that "the young person who's uninsured" at least comes "close" to affecting the overall market. Roberts preceded most of his inquiries by noting the government's position that the health care market is unique because those without insurance raise costs for those with it, and that almost everyone eventually will need health care services. "Surely regulation includes the power to promote," the chief justice said. Looks like Kennedy and Roberts will be the swing votes. As predicted.... Link to comment Share on other sites More sharing options...
physasst Posted March 27, 2012 Author Share Posted March 27, 2012 not the case... the justices expressed incredulity at the defense's attempt to parse the taxes associated with obamacare from being a penalty. his wordplay slipped several times, bringing laughter upon him from the court. if they are penalties, then the act is likely to be deemed unconstitutional. if they are indeed revenue streams, then it might slide. the penalties paid by citizens hardly make a dent in the cost of the act, so its becoming increasingly clear that that arguement isnt sound. you are a glass half full kind of guy. Actually, the federal government, IE; the Solicitor General, has argued that it is NOT a tax. The argument for the AIA injunction was made by the Fourth Circuit court. A defender (Long) was assigned to argue this position by the COURT, not the Feds. http://healthaffairs.org/blog/2012/03/26/the-supreme-court-aca-arguments-timothy-jost-on-the-anti-injunction-act/ Link to comment Share on other sites More sharing options...
physasst Posted March 27, 2012 Author Share Posted March 27, 2012 not the case... the justices expressed incredulity at the defense's attempt to parse the taxes associated with obamacare from being a penalty. his wordplay slipped several times, bringing laughter upon him from the court. if they are penalties, then the act is likely to be deemed unconstitutional. if they are indeed revenue streams, then it might slide. the penalties paid by citizens hardly make a dent in the cost of the act, so its becoming increasingly clear that that arguement isnt sound. you are a glass half full kind of guy. Actually, the federal government, IE; the Solicitor General, has argued that it is NOT a tax. The argument for the AIA injunction was made by the Fourth Circuit court. A defender (Long) was assigned to argue this position by the COURT, not the Feds. http://healthaffairs.org/blog/2012/03/26/the-supreme-court-aca-arguments-timothy-jost-on-the-anti-injunction-act/ Link to comment Share on other sites More sharing options...
physasst Posted March 27, 2012 Author Share Posted March 27, 2012 Yeah, Kennedy was a little rougher than I thought, but to be honest, Roberts seemed to lean towards the mandate more than I thought at this stage... So, who knows at this point. Link to comment Share on other sites More sharing options...
physasst Posted March 27, 2012 Author Share Posted March 27, 2012 Yeah, Kennedy was a little rougher than I thought, but to be honest, Roberts seemed to lean towards the mandate more than I thought at this stage... So, who knows at this point. Link to comment Share on other sites More sharing options...
paul2834 Posted March 27, 2012 Share Posted March 27, 2012 What is everyone's opinion on the bill from a medical professional standpoint? I've seen the opinions of politicians and the common man on both sides, but the media hasn't put much spotlight relatively on providers. Link to comment Share on other sites More sharing options...
paul2834 Posted March 27, 2012 Share Posted March 27, 2012 What is everyone's opinion on the bill from a medical professional standpoint? I've seen the opinions of politicians and the common man on both sides, but the media hasn't put much spotlight relatively on providers. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 27, 2012 Moderator Share Posted March 27, 2012 should create a lot of pa/np primary care jobs once it goes through. many new folks will hit the medicaid rolls and we are uniquely situated to take care of those folks who many docs will refuse to see. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 27, 2012 Moderator Share Posted March 27, 2012 should create a lot of pa/np primary care jobs once it goes through. many new folks will hit the medicaid rolls and we are uniquely situated to take care of those folks who many docs will refuse to see. Link to comment Share on other sites More sharing options...
Joelseff Posted March 27, 2012 Share Posted March 27, 2012 should create a lot of pa/np primary care jobs once it goes through. many new folks will hit the medicaid rolls and we are uniquely situated to take care of those folks who many docs will refuse to see. E, how are we as PAs in primary care and in private practice, being dependent providers, situated to take on these pts if our SPs/practice wont take them? Perhaps it is more to the advantage of the NPs who own their own clinics and in states that allow PA ownership, but maybe not for most/many pc PAs. Or unless there will be new PC jobs at govt subsidized/run clinics or they medicaid more palatable for private practices. I must admit I havent read the act, just bullet points and talking head material. Sent from my VEGAn-TAB using Tapatalk Link to comment Share on other sites More sharing options...
Joelseff Posted March 27, 2012 Share Posted March 27, 2012 should create a lot of pa/np primary care jobs once it goes through. many new folks will hit the medicaid rolls and we are uniquely situated to take care of those folks who many docs will refuse to see. E, how are we as PAs in primary care and in private practice, being dependent providers, situated to take on these pts if our SPs/practice wont take them? Perhaps it is more to the advantage of the NPs who own their own clinics and in states that allow PA ownership, but maybe not for most/many pc PAs. Or unless there will be new PC jobs at govt subsidized/run clinics or they medicaid more palatable for private practices. I must admit I havent read the act, just bullet points and talking head material. Sent from my VEGAn-TAB using Tapatalk Link to comment Share on other sites More sharing options...
physasst Posted March 27, 2012 Author Share Posted March 27, 2012 What is everyone's opinion on the bill from a medical professional standpoint? I've seen the opinions of politicians and the common man on both sides, but the media hasn't put much spotlight relatively on providers. It's okay... There's things I'm not wild about, but the biggest problem is that it cannot exist on its own, or rather will not substantially lower costs on it's own. Think of a tripod. It needs 3 legs to stand or it will fall.... Same with health reform. 3 MAJOR areas needed to be targeted. 1. Insurance coverage.....that's what the ACA was all about, expanding coverage and refining the insurance business. No more recission, no more denial of pre-existing conditions, allowing college aged kids to stay on their parents coverage. 2. Financing of health care....we need to reform how we actually pay for health care, and it likely needs to be dissociated from employment. There are number of mechanisms (Prometheus, vouchers, etc.) to do this, but it is badly needed. This is not really addressed by the ACA.... 3. Delivery of health care.....we need to reform how we deliver care...make no mistake, this is the HARDEST of the three. Quality initiatives, ACO's and a reform of decision making are needed. There is "some" of this in the ACA, but no where NEAR enough to be considered complete. Tort reform won't save any money, but should be done as a "Carrot" for providers before they get whacked with some of the other provisions.... And like a tripod, with only one leg, the system won't stand well. Those are my complaints. As far as this bill, it's a start. Something had to give, and the status quo was not acceptable. The GOP hates it, even though it is their bill, VERBATIM....but they have no alternative answers..... Link to comment Share on other sites More sharing options...
physasst Posted March 27, 2012 Author Share Posted March 27, 2012 What is everyone's opinion on the bill from a medical professional standpoint? I've seen the opinions of politicians and the common man on both sides, but the media hasn't put much spotlight relatively on providers. It's okay... There's things I'm not wild about, but the biggest problem is that it cannot exist on its own, or rather will not substantially lower costs on it's own. Think of a tripod. It needs 3 legs to stand or it will fall.... Same with health reform. 3 MAJOR areas needed to be targeted. 1. Insurance coverage.....that's what the ACA was all about, expanding coverage and refining the insurance business. No more recission, no more denial of pre-existing conditions, allowing college aged kids to stay on their parents coverage. 2. Financing of health care....we need to reform how we actually pay for health care, and it likely needs to be dissociated from employment. There are number of mechanisms (Prometheus, vouchers, etc.) to do this, but it is badly needed. This is not really addressed by the ACA.... 3. Delivery of health care.....we need to reform how we deliver care...make no mistake, this is the HARDEST of the three. Quality initiatives, ACO's and a reform of decision making are needed. There is "some" of this in the ACA, but no where NEAR enough to be considered complete. Tort reform won't save any money, but should be done as a "Carrot" for providers before they get whacked with some of the other provisions.... And like a tripod, with only one leg, the system won't stand well. Those are my complaints. As far as this bill, it's a start. Something had to give, and the status quo was not acceptable. The GOP hates it, even though it is their bill, VERBATIM....but they have no alternative answers..... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 28, 2012 Moderator Share Posted March 28, 2012 E, how are we as PAs in primary care and in private practice, being dependent providers, situated to take on these pts if our SPs/practice wont take them? Perhaps it is more to the advantage of the NPs who own their own clinics and in states that allow PA ownership, but maybe not for most/many pc PAs. Or unless there will be new PC jobs at govt subsidized/run clinics or they medicaid more palatable for private practices. I must admit I havent read the act, just bullet points and talking head material. Sent from my VEGAn-TAB using Tapatalk I foresee city, county, and state run clinics opening up which hire a bunch of pa/np folks and have a limited # of "supervisors" who are basically administrators, much like at the indian health service, federal prisons, county std clinics, etc, etc Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 28, 2012 Moderator Share Posted March 28, 2012 E, how are we as PAs in primary care and in private practice, being dependent providers, situated to take on these pts if our SPs/practice wont take them? Perhaps it is more to the advantage of the NPs who own their own clinics and in states that allow PA ownership, but maybe not for most/many pc PAs. Or unless there will be new PC jobs at govt subsidized/run clinics or they medicaid more palatable for private practices. I must admit I havent read the act, just bullet points and talking head material. Sent from my VEGAn-TAB using Tapatalk I foresee city, county, and state run clinics opening up which hire a bunch of pa/np folks and have a limited # of "supervisors" who are basically administrators, much like at the indian health service, federal prisons, county std clinics, etc, etc Link to comment Share on other sites More sharing options...
burnpac Posted March 31, 2012 Share Posted March 31, 2012 I think that the Affordable Care Act is a good step forward, but didn't go nearly far enough in my opinion. But then again, I'm a single payor kind of guy. Here is the bad news for folks who want to see the ACA repealed. We will be left with a disaster of a health care system that will be infinitely more costly and unsustainable than the one under the ACA. We are currently delivering care to everyone in America in the most expensive way possible. Health care is not a market like consumer goods, and the free market solutions just don't apply here, and are certainly not cost effective from a public health standpoint. It is in everyone's interest to have a healthy America. Folks need to watch Fareed Zakaria's GPS special on health care. You may not agree with his conclusions, but it is an interesting perspective of how other industrialized nations have dealt with this problem, and created much better community health and outcomes in the process. He also debunks the notion that governments can't do it cheaper than the private sector. Nearly every industrialized county in the world gets more bang for the buck than the US. We have to objectively ask, "Why is this?" Link to comment Share on other sites More sharing options...
physasst Posted April 1, 2012 Author Share Posted April 1, 2012 I think that the Affordable Care Act is a good step forward, but didn't go nearly far enough in my opinion. But then again, I'm a single payor kind of guy. Here is the bad news for folks who want to see the ACA repealed. We will be left with a disaster of a health care system that will be infinitely more costly and unsustainable than the one under the ACA. We are currently delivering care to everyone in America in the most expensive way possible. Health care is not a market like consumer goods, and the free market solutions just don't apply here, and are certainly not cost effective from a public health standpoint. It is in everyone's interest to have a healthy America. Folks need to watch Fareed Zakaria's GPS special on health care. You may not agree with his conclusions, but it is an interesting perspective of how other industrialized nations have dealt with this problem, and created much better community health and outcomes in the process. He also debunks the notion that governments can't do it cheaper than the private sector. Nearly every industrialized county in the world gets more bang for the buck than the US. We have to objectively ask, "Why is this?" Steve, The "repeal and replace" plan, aka Ryan's plan, HAS A MANDATE too.....this is the part that kills me. In fact....Ryan's may be a bit harsher..as his is based on tax credits which are substantially larger than the tax penalty under the ACA.... In essence, if you do NOT purchase health care insurance under Ryan's plan, you do not get the credit, and essentially pay more in taxes.... “It’s the same,” says William Gale, director of the Tax Policy Center. “The economics of saying you get a credit if you buy insurance and you don’t if you don’t are not different than the economics of saying you pay a penalty if you don’t buy insurance and you don’t if you do.” http://www.washingtonpost.com/blogs/ezra-klein/post/there-was-a-reason-conservatives-once-supported-the-individual-mandate/2012/03/30/gIQAiddnlS_blog.html Link to comment Share on other sites More sharing options...
Planteater Posted April 1, 2012 Share Posted April 1, 2012 They are so not the same thing. I am not defending the plan you are talking about because I do not know enough about it, but to say a tax penalty for "disobedience" is the same as a tax credit for "obedience" is ridiculous. I'll just tell my kids that a spanking for disobedience is the same thing as getting a sucker for obedience- think that'll fly? If my 4 & 6 year olds can understand the difference then I am not understanding why the Tax Policy Center thinks we are too dumb. And not getting a credit is paying the SAME in taxes as you were before- it is not paying more. Link to comment Share on other sites More sharing options...
burnpac Posted April 1, 2012 Share Posted April 1, 2012 They are so not the same thing. I am not defending the plan you are talking about because I do not know enough about it, but to say a tax penalty for "disobedience" is the same as a tax credit for "obedience" is ridiculous. I'll just tell my kids that a spanking for disobedience is the same thing as getting a sucker for obedience- think that'll fly? If my 4 & 6 year olds can understand the difference then I am not understanding why the Tax Policy Center thinks we are too dumb. And not getting a credit is paying the SAME in taxes as you were before- it is not paying more. Call me cynical, but if the ACA is gutted, or thrown out, the only actions that the opponents of the ACA will take will be to shore up "business as usual" actions of the insurance companies and their lobbyists. We can't kick this can down the road and expect a different outcome. There is a reason the the US spends more per capita on health care than any other nation, and has some of the worst health status indicators. I was disappointed with the ACA because it didn't go far enough to address the core problems with the health care system. Whatever we call it, let's all hope that it is not too little, too late. Link to comment Share on other sites More sharing options...
Planteater Posted April 1, 2012 Share Posted April 1, 2012 Stephen- my comment was not to imply we should gut/throw out the ACA- I am not going to go there on this forum. I am just sick of all the rhetoric (on both sides) and was pointing out how ridiculous I think the William Gale quote is: the economics are most certainly not the same. Link to comment Share on other sites More sharing options...
burnpac Posted April 1, 2012 Share Posted April 1, 2012 Stephen- my comment was not to imply we should gut/throw out the ACA- I am not going to go there on this forum. I am just sick of all the rhetoric (on both sides) and was pointing out how ridiculous I think the William Gale quote is: the economics are most certainly not the same. WCA - My apologies, but I was just using your last post as a spring board to comment in general, and not to portray you as on one side of the other. I didn't get any sense of your position on the issues from your post. However, while the economics may not be the same, using the tax system, either by directly taxing folks as a penalty, or rewarding them as a credit, achieves the same goal, and that is to influence the behavior of folks in the way that the Congress feels is best. It is two sides of the same coin. Link to comment Share on other sites More sharing options...
Planteater Posted April 1, 2012 Share Posted April 1, 2012 Oh OK no worries! I understand what you are saying about using the tax system, but I still think a reward is a reward and a penalty is a penalty. One seems to force people to make the decision, while the other just convinces them. I see a big difference. Link to comment Share on other sites More sharing options...
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