Showing posts with label Health Care. Show all posts
Showing posts with label Health Care. Show all posts

Sunday, May 17, 2015

King v. Burwell

This post has been quite delayed. Around December of last year, I read the question put forward to the Supreme Court in King v. Burwell, and I was slightly perplexed as to why (besides for the obvious politics of the ACA) this case was granted certiorari.

On March 4, 2015 the Oral Arguments were made. Without going too deep into it, March was a busy month for me personally, and honestly I missed the whole proceedings.

The main reason I am writing this article now is that my interest was peeked, when I heard speculation that Chief Justice Roberts may either concur or agree with a majority in Obergefell v. Hodges to buy cover for ruling against the Government in King v. Burwell.

I do not like to tea read, particularly when it comes to the Supreme Court. After listening to quite a few oral arguments, I find speculation to be mostly pointless. That is not to say that oral arguments are pointless to listen to.

The Justices are not advocates; thus it is often difficult to ascertain how they will rule based off of the questions they ask. For example some of the most difficult question during the oral arguments for the Plaintiffs in Obergefell came from Justice Breyer, who in all likelihood will rule in favor of the plaintiffs.


Point One


The crux of  case lies with the reading of sections 1311 and 1321 of the ACA. While I understand that I am typically biased towards Justice Breyer, I cannot find an agreement from the Plaintiffs that satisfies his central point:
"If you're going to elaborate on that, I would appreciate your ­­ in your elaboration, I've read that, and this statute is like the tax code more than it's like the Constitution. There are defined terms, and the words you just used concern a defined term.  As I read the definition, there's a section, Definitions, and it says, quote, The term "Exchange" means, quote, an exchange established under 1311.  And 1311 says, An Exchange shall be a government agency, et cetera, that is established by a State.  Those are the definitions.  So then you look to 1321. And 1321 says, if a State does not set up that Exchange, then the Federal, quote, secretary shall establish and operate such Exchange.  So it says, "The Secretary is to establish and operate such Exchange," the only kind of Exchange to which the Act refers, which is an ­­ quote, "an Exchange established by a State under 1311." That's the definition.  So the statute tells the Secretary, set up such Exchange, namely, a 1311 State Exchange.... and there's nothing else in this statute....so that's throughout what they're talking about.  So what's the problem?"
After quite a long hypothetical from Justice Kagan, which very bluntly explains what a substitution is, Justice Breyer and the attorney for the Plaintiff get into a bit of a discussion on epistemology:
Mr. Carvin:  We implore you to examine these words in the context of the Act as a whole because our argument becomes stronger for five reasons.  To respond to Justice Breyer's point, he says such Exchange connotes that it's the same person doing it. But look at the provision on territorial Exchanges.  It says, territories can establish such Exchanges and then it says, "and shall be treated as a State."  So-- so-- 
Justice Breyer:  Yes, it does.  But you say connote.  No, it's not a question of connotation; it is a question of denotation.  Now what does that mean?  It means that the Federal government, the Secretary, is establishing a thing for the State.  And what is the thing? The thing that it is establishing for the State is defined as an Exchange established by the State. 
Mr. Carvin:  To ­-- 
Justice Breyer:   Now, that person from Mars, who's literal, which I usually am not, but a literalist, I think would have to read it that way.  But if you-- if you're not a literalist, well, at least you could read it that way.  Now you want to go into the context ­­ if you want to go into the context, at that point it seems to me your argument really is weaker.
Based off of Justice Breyer's statement it would appear that the Government's position is support by a literalist's interpretation, which is bad for the Plaintiff. Once again this was my impression before hearing the Oral Arguments.


Point B


When it comes to what Chief Justice Roberts and Justice Kennedy said during the proceedings, it was fairly brief.  Neither asked that many questions.  Justice Kennedy asked more questions, but due to how he ruled in the previous decision, it will be interesting to see how he will rule in this case.

When discussing the Plaintiffs position Justice Kennedy raises a very interesting conclusion for the Plaintiffs reading of  the Statute:
"Let me say that from the standpoint of the dynamics of Federalism, it does seem to me that there is something very powerful to the point that if your argument is accepted, the States are being told either create your own Exchange, or we'll send your insurance market into a death spiral.  We'll have people pay mandated taxes which will not get any credit on ­­ on the subsidies.  The cost of insurance will be sky­high, but this is not coercion.  It seems to me that under your argument, perhaps you will prevail in the plain words of the statute, there's a serious constitutional problem if we adopt your argument."
Once again I do not do tea leaf readings, but based on this quote, if Justice Kennedy were to accept the Plaintiffs argument, then he would have to rule that the Federal Exchanges are unconstitutional as promulgated.

And as with Bond v. United States, 572 U.S. (2014) in ambiguity, the Court must read a statute in a way where it does not impinge on the basic Federal-­State relationship.

When it comes to Chief Justice Roberts, once again, besides for procedural issues he was mostly silent.  Perhaps the most interesting question he raised was "If you're right ­­if you're right about Chevron, that would indicate that a subsequent administration could change that interpretation?"

In other words, if the Court does not agree with Justice Breyer, in that the governments reading is not based on ambiguity, and agrees with with government because of the statute being ambiguous, the next administration could take away healthcare for millions of Americans.


Point III


This section actually agrees in part with something Justice Scalia said. Quelle horreur, I know! Justice Scalia raise a very good point about the whole situation:
"What about ­­ what about Congress?  You really think Congress is just going to sit there while ­­ while all of these disastrous consequences ensue.  I mean, how often have we come out with a decision such as the ­­ you know, the bankruptcy court decision?  Congress adjusts, enacts a statute that ­­ that takes care of the problem.  It happens all the time.  Why is that not going to happen here?"
In this context, Justice Scalia is referring to a circumstance where the Court rules in favor of the Plaintiff. but it also begs the why hasn't Congress clarified the situation. Well, other than the fact that the lower courts have ruled in favor of the Government. Congress could easily have fix this problem and made this case moot and also secured health care for 8-9 million Americans.

It's the legislature's job to fix legislation when it is broken or too unclear (when it's beyond Chevron Deference.)  This is a similar argument to when a statute is declared unconstitutional. It is up to the legislature to strike it from the books. It's why Texas still has anti-sodomy laws on their books. It's also the reason why the Voting Rights Act remains disassembled after Shelby County.

It drives me crazy when these situations arise, because they are often times so easy to fix. And yet they seem to never get done.


Liam '15

Friday, June 29, 2012

A Tale of the Map

This is a post that I will probably repost about once a month from now until the subject matter is solved. America is a Federalist Society.  We have a large powerful Federal Government balance by individual state governments.  When working properly, Federalism has one massive advantage over other political systems: a system of trial and error.  States often share similar problems and common questions of governance. The strength of federalism comes when states with similar problems come up with different solutions.  After time passes, the nation as a whole can see how the two varying solutions have worked to solve the particular problem.

That's how federalism should work, anyway.  I have a feeling that it does not often happen. Stubbornness, pride, regionalism, and ignorance can prevent states from enacting proven measures. Furthermore, a practical solution to a perceived problem may interfere with a special interest. Vast amounts of wealth can be spent to change people's beliefs.

A few months ago, when the Republicans were in primary mode, a mini-controversy erupted around the issue of contraceptives. Primarily that they need to change the composition of the Supreme Court so that Griswold v. Connecticut, 381 U.S. 479 (1965) can be overturned. (Nothing says freedom quite like having your right to privacy utterly stripped away.) I was shock to hear this in the modern era, since I knew that Texas has both a high Teen Pregnancy rate and a poor sex education program.  It was even more disturbing to hear contraceptives being discussed, in general and not only for teens, because I'm an adult and I will place a piece of latex on my penis and have sex with whomever I want. It is insane to think otherwise, especially by people who claim to champion freedom.

While the Federal Government has a role in Sex Education, primarily through Federal funds distributed to states, the majority of the policies come from the state and local levels.A state can choose to implement comprehensive, abstinence only sex education, or leave it up to local school districts (Texas.)

The following is a series of maps, the majority created by the CDC, which shows  general trends in America based on Health, Education, and Socio-Economics.

The first set of four maps show the basic sexual health of the nation, at a state or county level.

Teen Pregnancy Rates:


Syphilis Rates:


Gonorrhea Map:


Speaking of Sex Education, here is what I think should be shown. It would defiantly help lower teen pregnancy, raise tolerance and awareness. And evangelical christian types really show love my method as it is a perverted version of abstinence only.


I'm joking of course. Obviously nobody should be pressured into being gay, just as nobody should be pressured into being straight.  Attraction is attraction: if you're gay you're gay, if you're bi you're bi, if you're straight then you won't have any fun you're straight. Oh yes, also always wear a condom, always! There is no acceptable reason to not wear one during recreational sex. And if you are having sloppy gay sex, use a non-oil based lube. I digress.

Moving on to something, much, much more serious, here is a map of America based on Heart Disease.
Heart Disease Map:
For shame America, for shame. How can Wisconsin, the land of beer and cheese, be one of the healthier states when it comes to heart disease.. For shame.

Here is what the up coming generation will look like.

High School Obesity:


Compared to heart disease and adult obesity, the government can play a much greater role, in a much simpler fashion in High Schools. From extended PhysEd to low calorie lunch options, home economics, and health courses, states can lower the obesity rate among teens.  Furthermore we can use federalism to find the best solution.

High School Graduation Rates:


Bachelors Degrees:


Prison Population:

Violent Crime Rate:

I was planning to show a Hate Crimes map; however, since it is up to the individual states to define what a hate crime is and to report them to the FBI, I decided to forgo a map. According to the FBI's data center in 2010, Mississippi had one agency  reporting hate crimes while Iowa had fourteen.  Mississippi claimed to have only 11 hate crimes (they claimed only 1 in 2009) while Iowa claimed 14 cases.  

I really have my doubts about the accuracy, since as I said before states define and report hate crimes. Mississippi and Alabama have a long history of hate crimes and a failure to prosecute them.  I question the accuracy for another anecdotal reason; I haven't ever heard of a movie called Iowa Burning

SPLC also claims  that there are currently 41 known active hate groups in Mississippi, while there are only 4 in Iowa. But unfortunately this methodology could easily be flawed, since Wyoming, the birth place of hate crime laws has only 2 reported hate groups.

And to be truthful I really am disappointed with the honesty of the numbers, because I wanted to use those statistics to take an honest look at hate crime policies in the US.  I am not fully convinced that the progressive is necessarily the best practical way to solve hate crimes.

For as much as I joke, name call, and argue there is one thing I will not belittle. Perhaps the most telling of all is this one map.

Poverty in America:

If there were an omniscient, omnipotent, and all loving god, I cannot think of any greater issue, any greater image that would disturb this god than the poverty map.
 

Maps 1-6, 11 come from the CDC; 7,8 come from the Census; 9,10 come from Wikipedia.

This country and our individual states can only improve when the American people educate themselves. Ask questions of politicians, ask question of journalist, just ask questions. People lie, statistics can be manipulate, and I could be entirely wrong on my assertions, but given what I have I believe we can find a solution to our greatest problems and move forward.


Liam '12

Freedom Just For Me

Wednesday, June 27, 2012

I think America's Scared to have a Man-Date

Holy shit. Lawrence O'Donnell was really right about something. Based on his background, it should come as no surprise that Lawrence does actually seem to be fairly competent with the USC. Perhaps I simply missed the conversation about what the individual mandate actually is, but when I finally looked it up to verify, I was shocked.





There is no such thing as the individual mandate. Wow. Lawrence is absolutely correct.

According to 26 USC § 5000A(g)(2)(A):
(A) Waiver of criminal penalties
In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.
Under this section of the IRS code, you cannot be thrown in jail for not having health insurance. It is that simple. Well simple is not the right word as the Patient Protection and Affordable Care Act is 906 pages long, and even by legal standards is fairly complex. But not going to jail over failure to pay the mandate tax, maybe someone in the Obama Administration should have explained this point, repeatedly.

26 USC § 5000A(g)(2)(B)(i)-(ii):
(B) Limitations on liens and levies
The Secretary shall not—
(i) file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section, or
(ii) levy on any such property with respect to such failure.
The IRS cannot file a lien or place a levy on a person for failing to pay the penalty created by the individual mandate.  So if Person A doesn't have health insurance, they will be slapped with an approximate $100 tax (fine); however the government cannot put Person A in jail, secure a lien, or place a levy.  Essentially as the law is written, there is no way for the government to get the money.  Therefore, if the individual mandate is the only section of the Patient Protection and Affordable Care Act to be struck down, it would seem consequence free for the Obama Administration. Yes that's right, the mean over-intrusive federal government is going to force you to have health insurance by doing nothing to force you to have health insurance.

Ass-hats.

I think the Obama Administration should  find an attorney and a cartoonist and have them come up with simple explanations for controversial laws, instead of having people just tune into Fox News where they hear stupid shit like death panels.


Liam '12

Freedom Just For Me