California leads appeal defending Obamacare

Deep impacts on Santa Clara County expected if Affordable Care Act is overturned

Responding to the latest effort to weaken or repeal the Affordable Care Act (ACA), California Attorney General Xavier Becerra announced he is appealing a district judge's December ruling that the landmark health care law is unconstitutional.

In a statement last week, Becerra announced he and 16 other state attorneys general were appealing U.S. District Judge Reed O'Connor's decision in the case Texas v. United States, which concluded that the individual mandate -- the requirement that citizens must purchase health insurance or pay a fine -- was unconstitutional. O'Connor went on to rule that the remaining provisions in the ACA were "inseverable" from the individual mandate and "therefore invalid" as a result of the decision, dismantling the entire framework of the health care law, also known as Obamacare.

Becerra immediately responded to the Dec. 14 by calling it "misguided" and an "assault" on 133 million Americans who rely on the ACA for its protections of patients with preexisting conditions. The ruling is now moving up to the Fifth Circuit Court of Appeals, and could eventually be reviewed by the U.S. Supreme Court.

Though Santa Clara County is not a party in the case and the appeal, county officials have kept a close watch on the case because of the deep impacts it would have on both the county's finances and health and hospital system as well as the health of the community, according to County Counsel James Williams.

Since March 2010 when the law was enacted, Williams said the ACA has been "incredibly positive" for the community, insuring more county residents and reducing the costs and burdens on the county's hospital system. He said that Santa Clara County has been "at the forefront" by showing how effective the Affordable Care Act can be.

"I think California has been able to show a lot of what was intended to happen everywhere in the country by having robust enrollment and robust outreach -- a state that was actually taking advantage of the flexibility and the structure under the ACA," Williams said. "And the results speak for themselves."

This is hardly the first time the ACA faced possible repeal. Last year the Republican-controlled House of Representatives and Senate sought to repeal part or all of the ACA through multiple bills that ultimately failed to muster enough votes. Burt Margolin, a consultant hired by the county to watch federal legislation, reported to supervisors last month that certain efforts to weaken the health care law -- reducing the individual mandate penalty and internal changes by the Centers for Medicare and Medicaid -- appear to have dropped enrollment by about 13 percent from last year.

Margolin said that, if the Texas case makes it to the Supreme Court, the ruling may be favorable. Earlier in December the majority of the court, including Justice Brett Kavanaugh and Chief Justice John Roberts, declined to review lower court decisions that found Kansas and Louisiana had violated federal law by defunding Planned Parenthood for apparently arbitrary reasons not related to performance.

"The speculation is that Roberts may have wanted to avoid pushing this fight into a contentious battle over health care at the Supreme Court level, and that may bode well should the Texas (court) case reach his court," Margolin said.

Last year, Margolin said an estimated 130,000 residents in Santa Clara County gained Medi-Cal coverage through the Medicaid expansion under the ACA, 68,000 of whom are served directly through the county's health and hospital system and Santa Clara Valley Medical Center.

Williams said the ruling by O'Connor "defies common sense" by claiming the law was effectively repealed last year when Congress reduced the individual mandate penalty down to zero, and that there are staggering ramifications to a ruling that claims every single word is struck from the ACA as a result. That includes components that won huge support, including allowing children to stay on their parents' insurance plans until age 26 and protections for people with preexisting conditions.

"It would upend the private health care system for everyone," he said. "And yet somehow the district court judge is saying 'Well, actually (Congress) meant to strike everything down."

It was clear last year that Congress didn't have the votes required to repeal the ACA in its entirety, and that a succession of bills and votes proved that, Williams said. O'Connor's narrow analysis is divorced from what took place in the Legislature and "fails to actually grapple with the body of the law as a whole," he said.

Williams said he couldn't say for sure how the ruling would fare in the Fifth Circuit or the Supreme Court, but he emphasized that the ramifications of the case are huge.

"This is the largest sector of the economy -- this is not a minor set of statutes that we're talking about," he said. "The ramifications for striking the entire Affordable Care Act would upend all aspects of the health care system, every single person, regardless of who your insurer is."

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27 people like this
Posted by Forget it
a resident of Cuesta Park
on Jan 12, 2019 at 10:44 am

Where is this "Affordable Health Care"?

The one I had, had a ridiculous monthly premium and an outrageous deductible that I needed to pay first, before the insurance would kick in.

That old ObamaCare plan did not work, do not force me to take it.

Do not penalize me for not wanting to participate in a failed and EXPENSIVE health care plan.

4 people like this
Posted by Resident
a resident of Old Mountain View
on Jan 12, 2019 at 4:33 pm

The ACA and the AHCA which modifies it ensure rising costs. I posted this last fall on FB, re-sharing it here since I actually did some research before opening my mouth.


My Facebook feed is full of despair over the AHCA passing the House, rightfully so, the AHCA is bad bill. It's most of the ACA with some window dressing around the edges to allow various opt-outs. I don't want to rehash the thing here, since you can find tons of synopses online. I thought the ACA was a bad idea, and the AHCA makes it worse. I would like to see affordable, quality health care in the US, that's why I dislike both bills.

Whether or not the AHCA passes, we have a big health care problem in this country, and that's of rising costs. Last year, health care was about 1/6 of our GDP. Government takes in about 1/5 of GDP as taxes. If we were to socialize these costs, as most of my FB friends propose, we'd have to double taxes to pay for it, which would kill the economy, or we cut way back on government to pay for healthcare instead, which is politically impossible.

Costs are rising because the health care industry has worked for decades to prevent competition, and we no longer have a health care "market", but more of a health care extortion racket. Market competition sucks for providers, since they have to keep undercutting the competition, or improving services, otherwise, people will buy from someone better or cheaper. In a healthy market, companies churn, going in and out of business all the time. It's hard work, but it's good for consumers. It's a lot easier to lobby Congress for exceptions to anti-trust laws, for protection from competition, for importation bans, and any other means of stifling this competition. Google "certificate of need" for an example; before opening an MRI facility, you have to ask your potential competitors for permission to do it. Think you'll get that permission? There are countless examples of these anti-competitive measures, such as the AMA limiting the number of licensed MD's and fighting nurse practitioners taking over MD work, device manufacturers preventing importation of effective, cheaper devices from abroad, the FDA being funded by US drug companies creating a massive conflict of interest, etc.

When we pay ten or a thousand times more for a medical service than someone in another country, where does this money go? It doesn't go to some doctor or drug company, it gets spread out among many hands in the giant medical cartel we've grown in the US. It goes to the insurance bureaucrat who makes you spend hours justifying the procedure, it goes to pay for the lobbyists who make sure cheaper alternatives aren't available, it goes to the middleman who marks it up because the law requires the middleman. Some of it goes to the doctor, the pharmacist, and the drug manufacturer, and a bunch goes to various investors who demand these companies maximize their shareholder returns. You're paying for all that with your high costs and high insurance premiums!

Fighting this inefficiency means fighting all the millions of people who make money off it. Winning this fight, means that millions of people will lose their livelihoods, which is a good thing in my book, since these are counterproductive jobs. We need to roll back decades of anti-competitive measures, which all the people I mentioned will fight tooth and nail. We need rampant supply-side competition.

Once you have a competitive supply, then you can start thinking about how to provide this service to people who still can't afford it, but it becomes a much easier problem since it's more affordable.

On the upside, there are people who are fighting this inefficiency. Google "surgery center of Oklahoma" for an example; some great surgeons opened a surgery center which has a price list, doesn't do funny billing to extort money, and accepts patients from anywhere, the catch, they don't deal with insurance. On the upside, their all-in cost is usually less than your copay with insurance in other places! We need more suppliers like these. The surgery center of Oklahoma has proven that hospitals can charge ~15% of what they charge now for the same procedures. That's a huge cost saving.

So, please, if you're going to fight for healthcare changes, fight the corruption which makes it expensive, don't try to figure out ways to socialize the costs of corruption, because it will breed even more corruption and few people will be able to afford health care at all.

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