Lawsuits could force feds to pay Obamacare insurers

[swag]

Source: Politico

By PAUL DEMKO

A pending court decision could force the Trump administration to pump billions of dollars into Obamacare insurers, even as the president threatens to let the health care law “implode.”

Health insurers have filed nearly two dozen lawsuits claiming the government owes them payments from a program meant to blunt their losses in the Obamacare marketplaces. That raises the prospect that the Trump administration will have to bankroll a program the GOP has pilloried as an insurer bailout.

Insurers are owed more than $8 billion in payments, and the tab is likely to grow. Insurers say spending restrictions Republicans forced on the “risk corridors” program during the Obama administration, aside from being illegal, are partly to blame for severe turbulence in some Obamacare marketplaces.

“[The Obama administration] repeatedly assured us it was there and it would be a clear obligation of the government,” said Tom Policelli, CEO of Minuteman Health, which is among the insurers suing the government over the shortfall. “Even the federal government is subject to the rules.”

The fiscal hit to the feds could be huge if the insurers win. And it would be one more embarrassing setback for Republicans, who likely saw their best shot at dismantling Obamacare slip away in the Senate’s failed repeal vote early Friday morning. President Donald Trump, meanwhile, has threatened to pull billions in funding from a separate Obamacare subsidy program he's labeled a "bailout" for insurers.

Read more: http://www.politico.com/story/2017/07/30/lawsuits-obamacare-insurers-241112

[stopbush]

1. And THAT is it in a nutshell. Ever since Marco Rubio played his little game

and got the funding for the risk corridors slashed "Obamacare imploding" has been a done deal. 95% of the "problems" with the ACA are the direct result of conscious, hurtful political decisions that have been made by the Rs to undermine the program. The fact that people are unable to afford insurance is the direct result of this R subterfuge. The fact that insurers are leaving the program and fleeing markets is a direct result of the Rs craven actions taken against the success of the ACA.

This truth needs to get out there, now. It should be the opening statement made by any D who happens to end up on the TV machine to discuss health care.

[KentuckyWoman]

21. I was against the ACA and still am.

precisely because it was set up to be a money trough for big insurance, big medicine and big pharm to wallow in.

I was yelled down repeatedly being told I didn't understand the provisions like no pre-existing clauses and no lifetime maxes, and better coverage for women, etc., more than made up for it.

What no one wanted to hear then was what I said from the start... political winds change.... and when they do insurance companies will figure out how to get those provisions dropped while keeping all the premiums and subsidies. It's what they wanted from the start and agreed to the provisions knowing it was only a matter of time before they could get the wallow they wanted.

I was told this is just a beginning and the Democrats would push later for more provisions.

Now here we are.

Honestly, if it were not for the millions who rely on ACA now for access to medical care I would say let it fail. It needs to die IMHO.

Instead we need to expand medicaid and medicare. There's no need to remake the wheel. It is so easy to do once we find the political will to do it. The benefits are beyond measure.

[stopbush]

22. What % of a person's yearly income do you believe they would need to pay in taxes

to support a medicare for all program? Just curious.

[WinkyDink]

24. What % do you think goes to the extravagant Defense budget? Just curious.

[stopbush]

25. Why use the RW tactic of answering a simple question with another question?

So, you go first. Answer my question about the cost of Medicare for all and I'll then answer your question about defense.

[KentuckyWoman]

28. I did the math years ago... not recently.

About 10 years ago I worked for nearly a year to uncover the money my various taxes to county, state, Federal went to medical care... including tax breaks to corporations, subsidies for R&D, subsidized payments to providers etc. You can guess that part was very difficult.

However, by the best estimate, that money, plus my own premiums and out of pocket costs averaged to about 32% of my gross income over the previous 40 years. This is by no means exact because the rate of government subsidies and tax breaks of various sorts has skyrocketed since the late 90's. So getting a handle on what was spent over the course of my adult life is challenging at best.

I don't expect single payer to be less expensive. I expect the same money we all pay in aggregate to provide medical care to more people once we pool our buying power. Initially the predators in the system would pitch a fit..... but eventually, if we keep our resolve as Americans, the economic predators would move on to something else.

So my answer to you is 32% but expect that to cover all out of pocket costs as well. It does come anywhere close to any of the other estimates because I come at it from a unique perspective.

[stopbush]

29. 32% seems high. Consider this:

Medicare is currently paid for by taxing 100% of people working in the US.

Those tax dollars are barely enough to cover seniors on Medicare, who account for roughly 19% of the population.

So the question is: how much would payroll taxes need to increase to cover 100% of the population as opposed to the current 19%? The current tax rate is 1.45% for the employee and 1.45% for the employer, or a 2.9% total. 19% divides into 100% 5 times, so one assumes that one would need to raise the payroll tax five-fold to cover 100% of the population. That would mean that the employee would pay a tax of 7.25% as would the employer, equaling a tax of 14.5%.

Add into this the fact that current Medicare recipients pay monthly premiums of $109 on average, or $1308 a year.

So do the math: if you earn $50,000 a year, your Medicare tax would be $3625 at 7.25%. Add in your premiums of $1308, and you're paying just under $5,000 a year per person for Medicare for All. Sounds good.

But what if you are a family with a spouse who doesn't work and two young children who don't work? How are they covered in the Medicare for All scenario? Surely, there would be additional premium cost involved. They can't be covered free of charge. That $5000 per year mentioned above covers ONE working person, not their family members. Even if you waive the payroll tax deduction and charge only the average monthly premium per person (as Medicare currently does), you are looking at an additional $3900 per year to cover a non-working spouse and two children. That makes your cost around $9000 per year, and that is equal to 18% of that $50,000 income you are earning.

And, to cover all bases, let's not forget that you are currently paying 6.2% of your income in Social Security taxes. Add that into the mix, and your combined Medicare for All and SS expenses for that family of 4 with one bread winner described above would be over 25% of your income. Maybe if you add in all those other factors you considered in your post you add another 7% to the cost, which would get you to 32%. But in my estimations, that would also include your contribution to SS.

That's still a bargain when compared to the taxes paid in European nations, and it's the true cost of having a truly socialistic approach to things. It is what it is. Let's not downplay the realities involved.

I don't have the answers. I do know that while Medicare for All might well be the best and fairest approach we could take toward universal healthcare, it comes with real expenses and real costs to real people.

[Hoyt]

27. Medicare and Medicaid are not going to get expanded anytime soon. In fact, the only way to get

that is the next decade or so is through a public option, unless people wise up and GOPers get voted out.

That public option -- or even Medicare for all -- are not going to be as cheap as people think, either. It may be the best thing to do, but not if people don't believe it. Heck, I was pushing for it in late 1970s, but there are too many opposed to it now and our education system isn't equipped to overcome peoples' stupidity.

[House of Roberts]

2. A sure thing would be for a Mexican Insurance Company to sue them through NAFTA

Investor-State Dispute Settlement law.

[They_Live]

9. brilliant!

use their own idiocy against them.

[Progressive dog]

23. Since Mexico is out of country,

they can't sell health insurance to us.

[Blue Idaho]

3. How much longer will Insurers keep funding a GOP that isn't doing what they are told?

Could this threaten to shut off the faucet that pours millions of dollars of insurance lobbyists money into the coffers of elected Republicans? Seems to me the GOP is not holding up their end of the pay to play bargain they have with the GOP.

[Wellstone ruled]

7. It will continue until Cigna and Anthem

complete their mergers. Most likely others will pursue this same idea. They need special Tax wavers for their major Investors and until that happens,you know damn well how the game will be played.

[procon]

4. Since this funding is part of the ACA law, how does Trump think

he has the legal means to arbitrary restrict it? It seems to me that the only way he could not pay those companies would be to actually pass new legislation to repeal or replace the ACA, or those specific parts of it. The Republicans just tried that and all they got was an epic failure.

If they want to keep humiliating themselves, let them try another round of votes and see if they can change hearts and minds. Regardless, the lawsuits will bury the Trump administration and they will still accomplish nothing else this session.

[BumRushDaShow]

16. There were other posts noting that last year a federal judge halted the payments

indicating that no specific appropriation had been made for this (e.g., am guessing in the manner of how they do the Farm Bill, which is a 5-year appropriations package), but put a stay on that order pending the appeal. The argument at this point being whether the original law actually included/assumed multi-year appropriations or required annual appropriations requests. Of course the current administration could drop any appeal.

However based on this OP, the insurer lawsuit appears to basically be going the contract law route, where they are arguing the government obligated the funds (via language in the law) and should pay (which would then lead back to the other case needing resolution - whether valid appropriations were made (and when) and are available, and if not, whether the subsidies already paid could then be considered "unauthorized procurements" (requiring a process for next steps), and how to go forward for future payments.

[PoliticAverse]

17. It's not about restricting the payments it is about providing them. The ACA neglected to provide...

for funding for any such payments.

[spooky3]

5. It's about time!

[calimary]

6. I swear, trump attracts lawsuits the way stray dogs attract fleas.

[not fooled]

8. Like pukes don't

give massive handouts to corporations on a regular basis.

They are only whining about this case because it helps people. And, the black guy.

Effin' hypocrites.

[FakeNoose]

18. It's because one-percenters think they're handing money over to poor people

...and we all know G-D well they'd never do that!

But all they have to do is pay their fair share of taxes, that's all we're asking for.
The entire economy is already skewed to benefit THEM (and only them.)
Why can't they just shut up and pay their taxes?

[MichMan]

10. When did progressives start supporting corporate welfare to insurance companies?

There is no business more hated than for profit insurance companies. I get that this is for the ACA, but seems to go against everything we have been opposed to for decades

Why are there so many that want the government to take money from taxpayers to ensure that the insurance companies can make more profits?

[swag]

13. I am most interested in as many as possible maintaining access to healthcare.

If that means that the insurance markets must be stabilized via government subsidies, so be it.

We don't have single-payer yet, so this will have to do.

Meanwhile, carry on smashing the state and all that. I salute you.

[MichMan]

14. Fines were too low

If the fines for not participating hadn't been set so low, a lot more young people would have been in helping the risk pool

[FakeNoose]

19. When this all goes to single-payer (and eventually it will)

...then it's a different story altogether.

For now the insurance companies get to think they're calling the shots.
We have to take baby steps before big steps.

[humbled_opinion]

20. Single payer tough nut

There are so many sacred cows, Tricare, Employee coverage, etc and the sheer cost to insure 350 million in a medicare type plan is beyond my math. I understand some countries can do it, but they don't have 350 million people, they also don't have a healthcare industry that makes as much money at all levels as our does. Over $4 trillion spent on healthcare per year. Currently not including expanded medicaid which is never going to end, there are about 12 million people using the Healthcare exchanges, so that means that roughly 260 million are using private insurance, Tricare, or Employee coverage, good luck on convincing them to buy in to single payer.

[Gothmog]

11. Lawyers are busy protecting the US from Trump

[Doug the Dem]

12. Had Enough Winning, Donnie Boy?

Turns out a country isn't the same as a company your Daddy gives you. Bummer!

[Omaha Steve]

15. The the GOPers that want to kill Obamacare

YOUR voters are watching...

K&R!

OS

[onetexan]

26. how could it not?

Once ACA was signed into law by Obama its provisions are to be enforced and executed per the law's stipulations. The government has obligation to pay on its debt. Someone please tell me if my thinking not correct here.