Posted on 07/02/2014 9:23:26 PM PDT by 2ndDivisionVet
America's crazy, patchwork health-care system just took another hit.
Which would you prefer: to have the ability to decide for yourself and your family the type of coverage you want to purchase on a health insurance exchange—and having your premiums subsidized by a defined contribution or voucher from your employer—or to cede that ability to your employer entirely, having them pick your insurance for you, but empowering them to decide, based on their personal religious beliefs, which services to cover and which to exclude?
After Monday’s Hobby Lobby decision, this is exactly the type of choice that more and more Americans will face.
When considered in the light of the entire Affordable Care Act and the struggle to reform how health care is purchased and provided to patients, Hobby Lobby is simply not that big a deal. After all, it does nothing to change the individual mandate to have health insurance, the Medicaid expansion, the variety of programs to improve the quality of health care in the United States and those programs aimed at changing the payment system and thereby reduce costs, such as Accountable Care Organizations and other demonstration projects. These are all proceeding unaltered by this latest ruling.
The Supreme Court’s conservative majority, however, does seem to have added one more reason to doubt the wisdom of having employers be the main sponsors of health insurance in the United States.
Employer-sponsored health insurance arose in the United States due to an accident of history. During World War II, the federal government set wage and price controls to stabilize the economy and guard against wartime inflation. Health insurance benefits, however, were exempt from the controls. In 1954, Congress passed legislation that carried this exemption into taxation, so that in the second half of the twentieth century, employer contributions to health insurance would not be subject to income and payroll taxes. Most Americans, as a result, get their health insurance through their employer.
But health economists and experts across the political spectrum deplore this system. It promotes job lock, fuels health care inflation and keeps wages down. But after 60 years, it has become ingrained into the American economy.
To minimize disruption and reassure most Americans, the Affordable Care Act kept employer-sponsored health insurance intact. The ACA includes an employer mandate enforced by a $2,000 per worker penalty: Employers with more than 50 full-time workers who do not provide insurance that satisfies a minimum requirement must pay.
The minimum requirement includes preventive services from vaccinations to cancer screening tests to cholesterol screening. It also includes contraception. The Hobby Lobby case basically says employers need not cover contraception in the health insurance it provides.
The conservative majority carefully sculpted its decision. It specified that it applies only to “closely held” corporations, those in which five or fewer people own 50 percent of the shares. It specified, “This decision concerns only the contraceptive mandate and should not be understood to hold that all insurance-coverage mandates, e.g., for vaccinations or blood transfusions, must necessarily fall if they conflict with an employer’s religious beliefs.” Corporations can’t use this exemption as “a shield for employers who might cloak illegal discrimination as a religious practice,” according to the court.
But these limits are not as limiting as they seem. The closely held corporation limit is no limit at all. It turns out that more than half of U.S. employees work for closely held corporations. While many are small, many, like Hobby Lobby, are large. And it gives an incentive for more employers to become closely held corporations.
The justices in the majority go to great lengths to state that the Hobby Lobby decision is limited to contraception. But no principle differentiates contraception from blood transfusions or vaccines—or, for that matter, any other health-care services that employers find objectionable on sincerely held religious grounds. The only principle the court seemed to provide is that contraception could be provided in other ways that were less burdensome to the religious liberties of corporations. For instance, the government could provide or finance the services rather than require corporations to do so. But that applies to absolutely everything—after all, Medicare and the VA system, which provide medical services to Americans across the continuum of care, show that the government can provide or at least finance any medical service you can imagine. (Ironically, this argument is easier to make for vaccines, which many state and local governments already provide to millions of Americans, than for contraception.) Furthermore, the court all but invited other employers to bring suits to test what the limits of this religious based exemption are and have it adjudicate the least restrictive method of providing a particular service. Activist judges indeed.
Laws and court cases almost always have unintended consequences. An unintended consequence of the Hobby Lobby may very well be to further undermine employer-sponsored insurance. There has never been a mandate requiring employers to offer health insurance. (The employer mandate under the ACA does not go into effect until next year.) Yet many employers—99 percent of employers with 200 or more workers—already choose to provide health insurance. Why? To attract and retain workers, and because it is much easier and cheaper for employers to provide insurance than for individuals to get it on their own.
The health-insurance exchanges change this calculation. They provide a way for workers to get insurance that is easy to shop for, affordable and cannot exclude them on the basis of pre-existing conditions. The exchanges also have two big advantages for workers. They offer much more choice than the typical employer. In the exchanges, most workers get to select from many different insurance plans at different price points. And workers get to retain the same insurance—with the same physician and hospital networks—even if they shift jobs or start their own company.
Nevertheless, many if not most American workers seem to still want employer-sponsored insurance. This is no surprise. While we may not like our current health insurance, we are anxious about what might happen in the great unknown of exchanges. And we are unsure if our employers’ contribution would be the same. So, all things considered, most people think it is better to go with the devil they know than the one they don’t.
Hobby Lobby adds one more reason to tip the balance against employer-sponsored health insurance, though. As of today, an employer can now refuse to cover contraceptive services based on religious beliefs. Tomorrow it might be vaccines, mental health or some other services. Many workers, especially women, might begin to think it is just better to have a voucher—or the equivalent, a defined contribution—from their employer and go into the exchange and decide what insurance plan to buy. Having my employer decide—or even having the power to decide—what basic services are covered now starts to seem intrusive and presumptuous.
On its own, Hobby Lobby will not end employer-sponsored insurance in favor of a voucher system. But it adds another reason for workers to want it to end. And the reasons will continue to accumulate—wider choice of insurance options, more job flexibility, more control over services, and so on. Check back in a few years. After Hobby Lobby takes hold, employer health insurance vouchers begin to look a lot more appealing.
Thanks to Sam Alito and friends, the end of America’s crazy patchwork system just got a little closer.
Took another hit? Took another hit?? You mean, some tiny little bit of good news after the mammoth ass reaming the government's given their masters over the last four years??
this f face is evil personified, I cannot go on as I will be banned!
well, that's what they did for 50 years before so what was the problem with that? Employers shopped the insurance provider market and obtained the best plan for the most affordable price for their employees. Perks made working for one company more attractive over another and so drove competition for job openings, improving overall productivity of that company.
Well, first, I don’t need birth control (pill form) because I’m a guy. Second, I’m celibate, so I don’t have to worry about accidentally becoming a father.
Can’t understand why so many women go crazy at wanting birth control. Are there really so many with an uncontrollable libido? Are a lot of them more like men than they want to admit? What’s wrong with this country? (that last one is rhetorical, don’t answer it)
The stupid, it burns.
Emanuel cannot possibly be this stupid. Let me, a mere non-MD laymen explain:
The Hobby Lobby case was not about contraception or the Affordable Care Act. It was about abortifacients and the Religious Freedom Restoration Act.
Blood transfusions are acute, life-saving treatment. Contraception is not.
Blood transfusions are not available over the counter, nor are their over the counter alternatives to blood transfusions. Plan B is available over the counter, and Plan B is an OTC alternative to the prescription Ella.
Lack of vaccination endangers others. Lack of abortifacient coverage does not endanger others.
Shall I go on? Ezekiel Emanuel, you are a modern day Goebbels. A propagandist, pure and simple, who lies big, and lies often.
Kool aide drinkers
Sorry Easykill. I think that's a good thing. Your ObamaCare sucks!
And a man duplicitous enough to outdo even his lying brother. Writing in a high-toned academic style , he ignores the statute that the decision was founded on, in order to attempt to stampede gullible voters. To wit: the Religious Freedoms Restoration Act of 1993:
” (1) the framers of the Constitution, recognizing free exercise of religion as an unalienable right, secured its protection in the First Amendment to the Constitution;
(2) laws ‘neutral’ toward religion may burden religious exercise as surely as laws intended to interfere with religious exercise;
(3) governments should not substantially burden religious exercise without compelling justification;
(4) in Employment Division v. Smith, 494 U.S. 872 (1990) the Supreme Court virtually eliminated the requirement that the government justify burdens on religious exercise imposed by laws neutral toward religion; and
(5) the compelling interest test as set forth in prior Federal court rulings is a workable test for striking sensible balances between religious liberty and competing prior governmental interests.”http://religiousfreedom.lib.virginia.edu/sacred/RFRA1993.html
The text of the law itself refutes every argument this clown can up with. To a true progressive like himself, the Constitution is a piffle.
Reminder: Hobby Lobby Provides Coverage for 16 Types of Contraception
http://www.freerepublic.com/focus/f-news/3174342/posts
Yay, thanks.
“Which would you prefer: ....”
I would prefer not have a Mengele figure offer me my choices when it comes to healthcare as if he and only he can come up with them. I would prefer to pay for my use of medical services as I use them and to have a fairly priced catastrophic ins policy in case TSHTF. I would prefer not to subsidize this group, that class, or some other arbitrary cluster of people who have been made to believe they have a claim on my earnings or my assets. And I would go a little further and prefer that know-it-alls like this ghoul would stay the hell out of my life and my choices.
YEP.
Plus there is that option during every enrolment period every year... "No, I do not want to participate."
The only bunch of jerks around that mandated buying their insurance according to their criteria is the feds.
Sorry Ezekiel, "no sale."
.
Get government out of it entirely! If a business wants to buy health insurance for none, some, or all employees, it’s no business but theirs. If I as a private citizen want to buy my own coverage, let me buy what I want. Make all health insurance tax free or charge the same tax no matter who buys it. Government meddling only ends up distorting the health care market which results in rising costs for everyone involved.
Another screed.
Allow me to apply the Constitution for a second. The owners of businesses get to decide whatever they provide. Closely held is irrelevant. In a non-closely held company, the shareholders could throw out management for a decision they did not like, so this is a non-issue.
The owners of a business may decide to provide, or not provide anything they want.
“Well, what about blood transfusions and Christian scientists!”
What about it? As long as it is made clear to you what the insurance your employer is providing covers, there is no conflict here. You are free to work for anyone you want. You are free to leave a company whenever you like. In fact, in America if you don’t want to work for a company that does not offer blood transfusions as covered by their insurance, we have this great way to avoid it.
DON’T INTERVIEW FOR THAT JOB!
Where did this entitlement mentality come from? If it is my business and I want to not provide something, FOR ANY REASON, as long as I have not agreed to provide in a contract and signed that contract, there should be no limits on what I can do in the sense of insurance provisions. Its my damn business!
And this extends to employment and commerce as well. If I don’t want to serve someone for WHATEVER REASON, I have a right not to. If I don’t want to employ someone for WHATEVER REASON, I have a right not to. We are at the point where I can be forced to give my product and labor against my will? What is this, Cambodia?!
If you want me to pay for something with my money or time, whether it be training you for a job, serving you or providing a product, or indeed covering you under a company health plan, YOU’RE DAMN RIGHT I GET TO DICTATE THE TERMS!
If you want to dictate the terms... PAY FOR IT YOURSELF!
I am sick of the extra-constitutional BS at this point. I have had it!
He is also the brother of Rahm Emanuel and was one of the architects of Obamacare, something blithely ignored by the piece, written by his eminence. “Thanks to Sam Alito and friends, the end of America’s crazy patchwork system just got a little closer.”
In other words, “we are one step closer to socialized medicine, also known as one ‘one payer.’ “
This evil useful idiot is a buffoon, but not the stupid kind; he knows exactly what he is doing. In every revolution, except the American one, this useful idiot would be the first to be sacrificed when the socialists take power. We are not there yet but how strange it is that the people promulgating the change have no idea they will be the first to be sacrificed. They never learn, rather refuse to learn when the truth is right before their eyes. John 8:32.
Dissolve the State boundary restrictions to health insurers and allow nationwide competition, and get rid of Obamacare, and this whole mess will sort itself out within 90 days.
Just pay for own damn birth control, it’s not expensive.
MOST employers already and for as long as I have worked picked the insurance for the employees. Usually you have 2 3 maybe 4 choices depending on the size of the company and you will contribute money according to the program you chose. Hobby Lobby changed nothing in this regard.
Just typical leftjerk sacre mongering..........
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