The 11th Circuit refused to follow the Florida lower court's lead in striking down the entire Obamacare act, but it did rule that the individual mandate is an unconstitutional extension of the Commerce Clause. This ruling issued from the usual 3-judge panel by a 2-1 vote. One of the two judges in the majority was a Clinton appointee.
The decision is subject to review, upon request, by the entire 11th Circuit sitting "en banc." Either the en banc 11th Circuit or the Supreme Court will have to tell us whether they agree that the individual mandate must go and, if so, whether the rest of the law is sufficiently severable that it can go forward without the mandate. There is a serious practical question, too, whether the law can be implemented without the mandate. I have real doubt whether the American insurance industry can stay in business if it's subjected to the new requirements for expanded and universal coverage, but does not receive the economic benefit of the mandated market. If that proves to be the case, will the bill be abandoned, or will Congress seek to promote a single-payer option by permitting the industry to bankrupt itself?
Here's a statistic from the ruling that surprised me: "In 2007, 57% of the 40 million uninsured that year used somemedical services; in 2008, 56% of the 41 million uninsured that year used somemedical services. . . . The medical care used by each uninsured person cost about $2,000 on average in 2007, and $1,870 on average in 2008." I would have expected the number to be higher.
The ruling contains this brief, helpful summary of the Act's nine sections:
Title I contains these four components . . .: (1) the insuranceindustry reforms; (2) the new state-run Exchanges; (3) the individual mandate; and(4) the employer penalty. . . .There's more detail about each of these Titles in the full document. It's the best summary I've run across so far.
Title II shifts the Act’s focus to publicly-funded programs designed to provide health care for the uninsured, suchas Medicaid, CHIP, and initiatives under the Indian Health Care Improvement Act. . . .
Title II contains the Medicaid expansion at issue here. Title II’s provisions also create, or expand, other publicly-funded programs. . . .
Title III primarily addresses Medicare. . . .
Title IV concentrates on prevention of illness. . . .
Title V seeks to increasethe supply of health care workers through education loans, training grants, andother programs.
Title VI creates new transparency and anti-fraud requirements for physician-owned hospitals participating in Medicare and for nursing facilities participatingin Medicare or Medicaid. . . .
Title VI includes the Elder JusticeAct, designed to eliminate elder abuse, neglect, and exploitation. . . .
Title VII extends and expands certain drug discounts in health care facilitiesserving low-income patients. . . .
Title VIII establishes a national,voluntary long-term care insurance program for purchasing community living assistance services and support by persons with functional limitations. . . .
Title IX contains revenue provisions. . . .
Appendix A . . . documents (1) the breadth and scope of the Act; (2) the multitudinous reforms enacted to reduce the number of theuninsured; (3) the large number and diverse array of new, or expanded, federally-funded programs, grants, studies, commissions, and councils in the Act; (4) the extensive new federal requirements and regulations on myriad subjects; and (5) how many of the Act’s provisions on their face operate separately and independently.
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