U.S. Court of Appeals for the Eleventh Circuit

According to the plaintiffs, the individual mandate was an abuse of power; the Medicaid expansions were unconstitutional; and the employer mandate took authority away from the states. The District Court determined the plaintiffs had grounds to bring the lawsuit. The District Court then focused on constitutionality. It decided that the individual mandate was an improper use of Congress’ legislative ability. The court said the mandate could not be separated from the ACA. The court threw out the obstacle to the employer mandates and handed the case to the federal government regarding the Medicaid expansions. There was not enough support for their claim that it was coercive. In the U.S. Court of Appeals for the Eleventh Circuit, they confirmed 2-to-1 the District Court’s decisions on the Medicaid expansions and the individual mandate. At the same time, it ruled the opposite, saying the individual mandate could be removed without destroying the rest of the ACA.

I am going to make arguments for both sides in this court case. The individual mandate does seem to be unfair. It essentially taxes a person if they are uninsured for a certain amount of time. An abuse of power meaning that it forces Americans to buy health insurance. However, not everyone can afford it. The only way to insure everyone is through Medicare-for-all. In the 2020 presidential race, several candidates support such a policy. Among them, Bernie Sanders and Elizabeth Warren. They are arguably the most vocal politicians regarding a complete overhaul of the ACA and private insurance. Even if private insurance remains, Medicare-for-all can still be available as a public option. Medicaid expansions are considered unconstitutional by the plaintiffs because they do the same thing as the individual mandate: make health insurance mandatory. The expansions are said to be coercive. Employer mandates do strip states of their authority. After all, the employers are under no obligation to listen to the state government if they provide insurance to their employees. These are private institutions.

The U.S. Court of Appeals Eleventh Circuit agreed with the plaintiffs on the individual mandate and Medicaid expansions being unconstitutional, but employer mandates were ignored. They differed on one point, and that is whether the individual mandate is separable. I concur with them that the ACA can exist without it. This becomes a politically motivated reason in future court cases. Conservatives try to dismantle the ACA one provision at a time. In this case, the reason is still political. Obamacare is the other name. Republicans are bothered by that since they wanted to be responsible for health care reform. In 2012, President Obama was still in his first term. The individual mandate can’t be used to repeal the ACA. Judges in the Court of Appeals made a decision that was correct because the individual mandate does get removed and the ACA doesn’t go anywhere.

An amici curiae brief arrived in the Supreme Court. It stated that the reason for the tax credit is to provide insurance through the Exchanges. Furthermore, it proved that there is no evidence that the existence of the tax credit relied on the creation of a state Exchange. Certain members of Congress knew that tax credits would be given to purchasers because of the Exchanges. State governments didn’t believe the tax credits were restricted to state-run Exchanges. States never thought that not setting up a state-run Exchange would lead to the disappearance of tax credits for citizens. June 2015: with a 6-3 ruling, the Court ignored the arguments. Chief Justice Roberts told the Court that tax credits were going to be in states that have federal exchanges. The Court interpreted the vagueness to mean that when all the writing of the ACA is read, tax credits should go to anyone who needs them. If not, it would interfere with the law’s goal of affordable health care for all Americans. The Court confirmed what state governments and members of Congress believed from the start: that tax credits are there for people who obtained insurance on state or federal exchanges.

In defense of the states, this was a misunderstanding of how the tax credits work. They thought that they needed to set up their own exchanges. Keep in mind, exchanges are how people get health insurance. The ACA is a federal policy, and that is why it wouldn’t make sense for a state to add more exchanges. I can understand why the states took this case to the Supreme Court. Only they could interpret the law. Tax credits are an incentive to buy health insurance through the exchanges (state or federal). It is the opposite of an individual mandate. What the act did is make health care more affordable. The tax credit is one way of doing that. More than 20 million people became insured. I believe that times are changing and that the ACA is the past. Health insurance must evolve and be like many other countries that give it for free. Tax credits and other incentives are not needed. Despite this, the decision is still significant. A potential buyer can get health insurance through any exchange and receive tax credits. Six judges in the Supreme Court read it like that.

Texas v. United States

March 2019: The House of Representatives acted. They say the plaintiffs are in no position to question Section 5000A (individual mandate). Then that Section 5000A is constitutional. Lastly, Section 5000A can be unconstitutional, but it is removable from the rest of the ACA. Section 5000A does not require one to purchase health insurance. Additionally, the shared responsibility payment is zero after the 2017 amendment. Meaning, the government can’t use the mandate. The state plaintiffs have no grounds because they say that Section 5000A will lead to further enrollment in Medicaid and CHIP and strain state finances. There is no evidence. Section 5000A didn’t have an enumerated power. If the Court decides that Section 5000A needs an enumerated power, it should be deemed an appropriate use of Congress’ taxing and commerce powers. “As the Supreme Court recognized in National Federation of Independent Business v. Sebelius, the ‘touchstone for any decision about remedy is legislative intent,’ and here Congress’s intent could not be clearer” (Wydra et al., 2018). The rest of the Act was still there when the shared-responsibility payment became zero in 2017, and since then the amendment shows that the protections for people with preexisting conditions, work properly without an enforceable mandate.

The House of Representatives provided facts for a few points. Citing the shared-responsibility payment is one example. Congress erased the individual mandate tax in 2017. Obviously, the ACA is still functioning today. I would take the House’s side in this matter. Protections for people with preexisting conditions is the Justice Department or Department of Justice’s (DOJ) next target. I do not like this move by the current administration; they don’t have any basis for removing it. The action is cruel and unnecessary because it is a fact that preexisting conditions exist. I only disagree with one point in the House’s brief, and that is the enumerated power. It is an opinion that Congress can do what they want. Referring to NFIB v. Sebelius (see first case) only supports their statement that an enumerated power would be within Congress’ jurisdiction. I don’t know if it is a fact based off the summary.

I am going to provide an example for why I would always take the House’s side over the Trump administration. The story has nothing to do with healthcare law, but it is still a legal case. Robert Mueller concluded his investigation into Russian interference in the election, collusion, and obstruction of justice. His report led to the indictment of many Trump associates including Michael Cohen, Paul Manafort, and Roger Stone. These are the big names. Many others got caught up in the investigation. In the end, unfortunately, Trump himself did not get indicted. Mueller said he is not in any position to do so; Congress would need to impeach the president. Many Democrats in the House have called for impeachment. One Republican named Justin Amash has joined them. I am seeing a party that is concerned solely with facts. Trump tweets almost everyday that he did not get exonerated by saying “no collusion.”

Despite the rambling, House Democrats have been pushing through subpoenas to gather facts. The biggest one has been Robert Mueller himself. On Wednesday July 24, 2019, the special counsel appeared in the capitol to testify. The Mueller Report is nearly 500 pages long and has nothing but facts. He was there to confirm everything that is written in there. Trump went on a tweet storm that morning. His reaction is further proof of the fact that Russia interfered in the 2016 presidential election. Nitpicking the report is something that both Attorney General William Barr and Trump both did. Barr provided a three-page summary of the Mueller Report that contained what Trump wanted to hear and nothing else. Additionally, much of the report is redacted. Therefore, I agreed with the House in the Texas v. United States case because the same pattern of gathering facts is present in the opening brief.

A pharmacy owner in Miami is arrested for a crime that defrauded Medicare $8.4 million (Beaton, 2019). Antonio Perez Jr. said that he gave kickbacks to Medicare recipients to get them to buy their prescriptions at Valles Pharmacy Discount. Perez also stated that his pharmacy replenished expensive prescriptions that were not given to people on Medicare. A fourth of the $32 million were for drugs that didn’t exist (Beaton, 2019). Perez gave up his property and bank accounts.

The $32 million stands out to me. That is a very large sum of money. I am curious how they made up drugs. $8 million is a fourth. Perez’s amount matches up with that. I assume he charged Medicare recipients for these non-existent drugs. The summary did not indicate who else was involved in the scheme or how long Perez’s prison sentence is.

A Detroit man received 11 years in prison for stealing $8.9 million from Medicare through home health care and physician claims (Beaton, 2019). There were a few different crimes. Millicent Traylor got one count of conspiracy to commit healthcare fraud, five counts of healthcare fraud, and one count of conspiracy to pay and receive healthcare kickbacks (Beaton, 2019). Traylor and three others provided medically unnecessary services for home health companies. Traylor did not have a physician license in his state, but billed Medicare regardless. Traylor and the others altered medical records, signed fake documents, and participated in kickback operations to rip off Medicare beneficiaries at home health clinics (Beaton, 2019). Traylor gave fake prescriptions for opioids like oxycodone as well.

Traylor stole more money than Perez. $8.9 million is about half a million larger than Perez’s $8.4 million. 11 years is a long time and that is what Traylor deserves. The number of felonies add up to 7 crimes in total. The unique part about this case is the missing license. Knowingly contributing to the opioid crisis is evil. Oxycodone prescriptions should get a longer sentence. Perez also profited from prescription fraud.

A Houston patient recruiter got a 9-year prison sentence bringing in $3.6 million in a Medicare fraud scheme (Beaton, 2019). Mercy O. Ainabe gave away patients’ personal information to home health places. Ainabe and friends used a place called Texas Tender Care to generate claims for medically unnecessary services or ones that didn’t happen (Beaton, 2019). The trial revealed that Ainabe paid beneficiaries, providers, and physical therapy companies to help her get away with it. She posed as a marketing representative. Those that investigated all three cases include HHS, OIG, and the Medicaid Strike Force Unit.

A commonality to the Traylor case is that home health was the target. What is unique about this case is that Ainabe tried to fool law enforcement. Paying off companies and pretending to be a marketer is very elaborate. The crime didn’t allow the strategy to work. If my personal information was given away by her, I would be furious. Getting billed for services that didn’t happen should not escape the patient’s notice. I would remember what happened. It is understandable that some people might ignore the medically unnecessary services because they don’t know anything about them. Ainabe’s prison sentence is fitting.

In conclusion, the court cases challenging the constitutionality of the ACA or Obamacare and Medicare fraud criminal cases can be described as an attack on healthcare in the United States. On one end, the Trump administration is trying to strip away health insurance from more than 20 million people. The other side is an enormous loss of money over the years. As a result, this country will be the worst place to get health insurance. Health care reform and fraud prevention are the only solutions.