Wednesday, September 30

Fast talker











The first question in the first 2020 presidential debate focused on Donald Trump’s effort to place a third justice on the US Supreme Court – and the topic quickly turned to health care and Republican efforts to end the Affordable Care Act. 

The Affordable Care Act, aiming to increase preventive care and curb the rising costs of health care, imposed regulations on the industry. The Trump administration and a group of states have asked the US Supreme Court to strike down the Affordable Care with arguments scheduled for November 10, a week after the election. Trump hopes to have his nominee on the court by then.  “The case centers on Republicans’ move to use the 2017 tax overhaul to nix the law’s penalty for most Americans who don’t get health coverage,” reports Todd Ruger for Roll Call. “The Trump administration and the Republican-led states argue that move made the mandate to buy insurance unconstitutional.”

Ruger raises the possibility that the court will resist wiping out the entire law even if it finds that a small sliver is unconstitutional. Trump and the Republicans who oppose the law suggest the mandate is central to the Affordable Care Act – and that the entire law should be scrapped. 

As was emphasized during an early exchange in the first presidential debate, the administration has no substitute health plan waiting in the wings.

Moderator Chris Wallace: You have promised to repeal and replace Obamacare, but you have never in these four years come up with a comprehensive plan to replace Obamacare…
President Trump: Listen, listen … of course, we have…  I got rid of the individual mandate… excuse me, we got rid of the individual mandate, which was a big chunk of Obamacare…
Wallace: That is not a comprehensive plan.
Trump: That is absolutely a big thing…that was the worst part of Obamacare.
Wallace: I didn’t ask, sir…
Trump: Chris, that was the worst part of Obamacare.
Wallace: Let me ask my question.
Trump: Well, I’ll ask Joe. The individual mandate was the most unpopular aspect of Obamacare.
Wallace: Mr. President...
Trump: I got rid of it and we will protect people with per-existing conditions...
Wallace: Mr .President, I’m the moderator of this debate and I would like you to let me ask my question and then you can answer.
Trump: Go ahead.

That exchange of about 150 words lasted 35 seconds, about twice the pace of that for the average US speaker. The speed, tone and many interruptions reflect why the debate was so painful to follow.

Studies suggest that people judge individual intelligence based on one's voice and how fast one speaks - though "Not too fast, of course, or they won’t understand a word you’re saying," reports Ian Lee for Lifehack. "Nevertheless, faster speakers are perceived to be more confident..."  

Ending the Affordable Care Act without a suitable replacement during the Covid-19 pandemic would be unconscionable. The individual mandate – while ensuring that society could pay for affordable care and efforts to ensure all – was not the biggest or most notable aspect of the Affordable Care Act. A decision to discard the entire law due to the mandate would eliminate the many benefits associated with the Affordable Care Act over the past decade. 

 Those benefits apply to far more than the than the 23 million Americans who would otherwise be uninsured and would also hurt Americans who have employee-sponsored insurance, including: 

-    Allowing parents to keep adult children on family health plans until age 26.
-    Reducing health care costs for small businesses with a care tax credit
-    Expanding mental health treatment
-    Eliminating annual and lifetime coverage limits
-    Preventing denial of coverage due to pre-existing conditions
-    Limiting  administrative costs and profits of insurance companies to no more than 20 percent for plans sold to small employers and 15 percent for plans arranged by large employers. 











Health care is a business in the United States and represents about 18 percent of the economy. Companies make money on patients, and the careers of thousands of doctors, nurses, pharmacists, insurers and many more workers in the health care field depend on the system, too.

All is not lost and analysts expect the US Supreme Court – even with an additional conservative justice to replace the late Ruth Bader Ginsburg – to support the law.  “Constitutional litigation is not a game of gotcha against Congress, where litigants can ride a discrete constitutional flaw in a statute to take down the whole, otherwise constitutional statute,” wrote Justice Brett Kavanaugh in the majority opinion on another aspect of the case in 2015.

Source: Affordable Care Act benefits, The Balance.

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