Originally Posted by playwrite

I'm certain that nearly all on the Left want single payer or at least the public option; it’s only a matter of tactics of how best to get there. The reality is that ACA is now the starting point. Tactically, the way to proceed from here is to work for the public option at the state level or even better in multi-state regional exchanges, further expand eligibility of Medicaid, raise the subsidies, and lower the age of Medicare eligibility. Each of those things is now below-the-fold if even on the front page of a newspaper and therefore much more politically doable once things start settling down.

The question for those on the disappointed Left is - do they want to keep whining about not getting the magic pony or do they want to get their hands dirty and make something happen that actually moves the system towards what we agree is better.

.

PW, you sure have a way with words. How about we keep this conversation on a friendly level? You know that we have much in common with many issues. This one is particularly close to my raw nerves because I have worked on single payer for so long. It was hard seeing backroom deals being made with the ACA and single payer people left out of the promised inclusion in the campaign talks. Yet the pharmaceutical and insurance industry was at the table. Not an appealing image, is it?

I'm not looking for a *magic pony*. I'm looking for a chicken in every pot. Most of the people that you say are whining, have been working on health care issues for a very long time, including myself. Wendall Potter who used to work for the insurance industry, and knows the root problems of ACA, is trying to educate people about the sludge at the bottom of the pond. Anything I post here is from organizations and individuals who have been in the thick of working for equitable health care.

However, as opposite as it may seem, I am grateful that at least many more people will be covered. This current situation is a good opportunity for many of us to work even harder for a more equitable health care for all. But part of that work is knowing the nuts and bolts of the ACA and holding it up for all to see.

Originally Posted by Deb C

PW, you sure have a way with words. How about we keep this conversation on a friendly level? You know that we have much in common with many issues. This one is particularly close to my raw nerves because I have worked on single payer for so long. It was hard seeing backroom deals being made with the ACA and single payer people left out of the promised inclusion in the campaign talks. Yet the pharmaceutical and insurance industry was at the table. Not an appealing image, is it?

I'm not looking for a *magic pony*. I'm looking for a chicken in every pot. Most of the people that you say are whining, have been working on health care issues for a very long time, including myself. Wendall Potter who used to work for the insurance industry, and knows the root problems of ACA, is trying to educate people about the sludge at the bottom of the pond. Anything I post here is from organizations and individuals who have been in the thick of working for equitable health care.

However, as opposite as it may seem, I am grateful that at least many more people will be covered. This current situation is a good opportunity for many of us to work even harder for a more equitable health care for all. But part of that work is knowing the nuts and bolts of the ACA and holding it up for all to see.

I understand. Sorry. I'll cool it. Thanks for you being nice about it.

The chicken in the pot was really good.

Corporate Welfare on steroids

Health Care is about Patients, not Political Careers

From Dr. Margaret Flowers

The Supreme Court review reinvigorated the healthcare debate, but we hear partisan talking points rather than an honest review of the law. This will likely worsen as we get closer to Election Day.

The current law is based on policy developed by the Heritage Foundation, a conservative think tank. Romney passed this law in Massachusetts, then Obama passed it at the national level. Right now Democrats are celebrating the Supreme Court decision to uphold the law while Romney is threatening to repeal it. If a Republican had passed this federal law, we would have the opposite situation.

Let’s put politics aside and look at the law from a policy standpoint. The big winners of the Supreme Court decision are the corporations who are profiting from the current health system – private health insurers, pharmaceutical companies and the for-profit corporations that are buying hospitals and medical practices.

It is now deemed constitutional to require people to spend up to 9% of their income to purchase private insurance despite it being a defective product. People with insurance continue to face financial barriers to care. They delay and avoid necessary care because of the cost of co-pays and deductibles. When patients have a serious medical condition, they risk financial ruin. The greatest causes of bankruptcy in the US are medical illness and medical costs, and 4 of 5 people experiencing medical bankruptcy had health insurance. All these problems have worsened in Massachusetts where 63% say they are worse off after five years of RomneyCare.

The purchase of private insurance is going to be subsidized with taxpayer dollars, $447 billion between 2014 and 2019. The insurance mandate and the subsidies create corporate welfare on steroids.

http://itsoureconomy.us/2012/06/heal...tical-careers/

Originally Posted by playwrite

The question for those on the disappointed Left is - do they want to keep whining about not getting the magic pony or do they want to get their hands dirty and make something happen that actually moves the system towards what we agree is better.

One of the things that attracted me to Obama in the 2008 primary debates was his willingness to get his hands dirty.

Originally Posted by Deb C

Corporate Welfare on steroids

Health Care is about Patients, not Political Careers

From Dr. Margaret Flowers


http://itsoureconomy.us/2012/06/heal...tical-careers/

Debs, if you want to continue this line of bashing away that we didn't get the magic pony, then I'm going to have to keep defending what we did get, where we can realistically go from here, and why magic ponies never actually poop out single payer or gold nuggets.

The choice is yours, me lady.

We can start with dueling facts or opinions such as how Romneycare has faired with an excellent synopsis here -

http://www.factcheck.org/2011/03/rom...nd-falsehoods/

that includes this -

Plenty of Satisfaction

Claim: “… people were greatly dissatisfied.” — Huckabee
Claim: “Massachusetts has a state health insurance program that they’re happy with.” — Barbour

Score one for Haley Barbour. The state’s health care efforts haven’t been plagued by claims about grandma’s life-support, as we saw on the federal level. For now, public support and physician support are both high in the state.

Surveys by the Urban Institute and the BCBS of Massachusetts Foundation found that 67 percent of nonelderly adults in the state supported the health care law in the fall of 2009; in the fall of 2006, a few months after it was passed, 68.5 percent supported it. Another 2009 survey by the Harvard School of Public Health and the Boston Globe found 59 percent of state residents supported it, which was also similar to the poll’s 2006 number, 61 percent. In 2009, 28 percent opposed it and 13 percent weren’t sure. Support was much higher among Democrats and Independents than Republicans. Those are the most recent surveys we found.

Among practicing physicians, 70 percent supported the law in a fall 2009 survey, also from Harvard. That poll, published in the New England Journal of Medicine, also found that 60 percent of physicians said the law didn’t have much of an impact on how long patients wait to get an appointment (and 2 percent said there was a positive impact). Eighty-five percent said the law either had not much impact or a positive impact on the quality of care patients receive.

Bills haven’t been filed to repeal the individual mandate, says Rosman with Health Care for All. And there was no taxpayer revolt when the state asked residents to confirm their insurance status on their tax returns. “We were totally expecting a big issue,” particularly from libertarians, he says. “I expected people to write on their tax return, ‘Go to hell.’ ” Instead, more than 98 percent of tax filers complied.

Originally Posted by Earl and Mooch

One of the things that attracted me to Obama in the 2008 primary debates was his willingness to get his hands dirty.

Yea, I really like how he came out and said it was obvious he didn't do this for political advantage.

Originally Posted by playwrite

Debs, if you want to continue this line of bashing away that we didn't get the magic pony, then I'm going to have to keep defending what we did get, where we can realistically go from here, and why magic ponies never actually poop out single payer or gold nuggets.

The choice is yours, me lady.

We can start with dueling facts or opinions such as how Romneycare has faired with an excellent synopsis here -

http://www.factcheck.org/2011/03/rom...nd-falsehoods/

that includes this -

Oh fine sir, tis not bashing as much as it is another side of the coin.

Originally Posted by Deb C

Oh fine sir, tis not bashing as much as it is another side of the coin.

It's bashing if it's constant and repetitive parroting of: half-truths ("63% say" health care costs have gotten worse - imagine what they be saying if their Romneycare wasn’t actually paying for much more of that than the before-situation); obfuscation of the truth ("9% of their income" to buy something that most people should have, many of these people are subsidized up to incomes of $44000 for an individual and $88,000 for a family); silly notions that federal taxes pay for anything (see MMT posts); and the absolute magic pony land statements of "lets put politics aside."

If you want to play this game, you're going to have to get serious - check your sources, not be afraid to put it in real context, and recognize that its all politics - if you don't, then you're just bashing.

Maybe it would be more profitable to look at the holes in Obamacare and how they could be patched to further move us down the path. For example, where is a state/regional exchange likely or not likely to offer a public option? Why is that? What is making that happen or not? What could be done about it?

Something about lighting a candle rather than cursing the darkness, hey? At this point, I see the national organizations and blogs that continue to dis Obamacare from the Left as being nothing more than cursing the darkness with a little of ego trip thrown in. What they want isn't going to happen in my lifetime and possible yours.

What can happen is state-by-state as well as by federal legislation piece-by-piece will move us closer - sometimes just small tiny steps that barely anyone outside of the sector is aware. But also by huge steps such as California putting a public option in place and other Western states latching on that brings overnight 10s of millions into single payer - that is a mighty big candle. You add in NY taking New England down the same route and you got maybe 50% of the nation's population covered. Think about it.

From a personal appeal, I would prefer not having to shore up my flank with friends when I got my hands full taking on the real sociopaths.

Originally Posted by JustPassingThrough

There is good reason why this law is so unpopular. In a nutshell, what it does is to attempt to provide coverage to the purported 15% who don't have it (overwhelmingly young people who don't want it), by making things worse for the 85% who already had insurance, including those on Medicare. Way back, three years ago, I was saying the only hope for the Democrats is that this law never goes into effect. If it does, it's going to destroy them for decades, even among people who have been Democrat-leaners. 2010 was just the beginning.

This law and all of its ill effects are now SQUARELY back on the front burner, and will be the #1 issue of the 2012 election, in tandem with the economy as a whole, because the two are so heavily related.

Where do you get your data? According to the CBO, you're wrong ... and they do this sort of thing all the time. BTW, you're still wrong if the CBO uses GOP assumptions.

Originally Posted by playwrite

Everyone should go outside or at least look out the window!

There are confidence fairies flying all over the place!!!


[note - it helps to take certain other pills or tabs of certain sugar cubes to see them clearly]

H-m-m-m. If he was still alive, Owsley Stanley would be proud.

The fine is the most-unpopular thing about ACA, which is what JPT largely uses to claim that it will hurt Democrats and liberals in the future. The problem with it is that the person who pays the tax gets nothing for his/her money; it just goes into the pot for those who DO get insurance coverage (including those subsidized in small part by those who pay the fine). As Deb pointed out on page 1 of this thread, it is already the case that taxpayers pay now for coverage that they don't get, such as for government employees, or for coverage they don't get until they are 65. But I wonder if it would be wise or possible to give fine-payers a credit of some kind; such that if they decided later to get insurance instead of pay the fine, they could get credit for money already paid. As I understand it, this fine also applies to employers, and the same provision could be made there. This would be considered retroactive payment. Something for Democrats and liberals to think about, if they are afraid of campaign rhetoric from the trickle-downers like JPT?? Would that work, or would it bust the budget?

Senator Says Employers Should Be Able To Deny Coverage To Cancer Patients Because ‘Our Nation Was Based On Freedom’

The extremist Right has so bastardized the worlds "freedom" and "liberty" that it makes me nauseated to even hear the terms. They can take their "freedom" and "liberty" and shove it up their rear ends.

So I'm not accused of pulling facts out of the air, here's a piece by:

Marcia Angell, M. D., is Senior Lecturer in the Department of Social Medicine at Harvard Medical School. She stepped down as Editor-in-Chief of the

New England Journal of Medicine on June 30, 2000. A graduate of Boston University School of Medicine, she trained in both internal medicine and anatomic pathology and is a board-certified pathologist. She joined the editorial staff of the New England Journal of Medicine in 1979, became Executive Editor in 1988, and Editor-in-Chief in 1999.

Although there are some provisions to curb the worst abuses of the insurance companies, such as excluding people with preexisting conditions, there is nothing in the law that would stop insurers from raising premiums. A senior executive of the industry's trade association, America's Health Insurance Plans, told me privately that that's exactly what the companies will do if regulations cut into their profits. Thus, costs under Obamacare will almost certainly rise even faster than at present. No reform can work well or very long if its costs are unsustainable.


In fact, it is unlikely that Obamacare will ever be fully implemented as it stands. If Romney is elected, with a Republican Congress, it will be quickly overturned. If Obama is re-elected (and I hope he is, despite my disappointment in his health plan), it will come apart more slowly. But unravel it will, as costs rise and it becomes clear that there are still tens of millions of Americans priced out of the system.

Here's how the unraveling will look:

Many of the uninsured who are subject to the mandate to purchase private insurance will choose to pay the penalty/tax instead. That will lead the insurance companies to raise their premiums, demand that the penalties be greater, or both. Deductibles and co-payments will increase to the point that many people will have insurance they can't afford to use. (This is the case in Massachusetts.) Many employers will simply stop offering health insurance, since our high unemployment means workers no longer have the leverage to demand it, or they will stop insuring dependents (thus avoiding having to cover grown children to age 26). In addition, because insurers have a strong financial incentive to evade the new regulations requiring them to take all comers, it will take a huge bureaucracy to monitor them.

http://www.huffingtonpost.com/marcia...b_1637397.html

Originally Posted by Odin

Senator Says Employers Should Be Able To Deny Coverage To Cancer Patients Because ‘Our Nation Was Based On Freedom’

The extremist Right has so bastardized the worlds "freedom" and "liberty" that it makes me nauseated to even hear the terms. They can take their "freedom" and "liberty" and shove it up their rear ends.

The election of 2010 looks increasingly like a great shame -- nostalgia for a failure of a 3T that had gone sour. America is stuck with some of the results, like this Senator, until the beginning of 2017.

Originally Posted by Deb C

So I'm not accused of pulling facts out of the air, here's a piece by:

Marcia Angell, M. D., is Senior Lecturer in the Department of Social Medicine at Harvard Medical School. She stepped down as Editor-in-Chief of the

New England Journal of Medicine on June 30, 2000. A graduate of Boston University School of Medicine, she trained in both internal medicine and anatomic pathology and is a board-certified pathologist. She joined the editorial staff of the New England Journal of Medicine in 1979, became Executive Editor in 1988, and Editor-in-Chief in 1999.



http://www.huffingtonpost.com/marcia...b_1637397.html

Facts???

Actually, this is a very good example of what I'm talking about. Let's take it apart -

Although there are some provisions to curb the worst abuses of the insurance companies, such as excluding people with preexisting conditions,

- a fact that is an ACA attribute

there is nothing in the law that would stop insurers from raising premiums.

a platitude at best that doesn’t mention that this is true whether there was or wasn't an ACA. Also says nothing about how much more transparent, now with ACA, any attempted changes in premiums via-a-vis offered benefits against more standardization (e.g. silver-, gold- level plans) and the much more highly competitive environment of the exchanges being set up where not only those differences can be compared but any price collusion is much more likely to be noticed by regulators. And most importantly, it says noting about ACA’s Medical Loss Ratio provision which is set at 85% for the Group market and 80% for the Individual market – essentially, with any increase in premiums, 80-85% of that increase has to be paid out in benefits or the insured get a rebate for the difference.

A senior executive of the industry's trade association, America's Health Insurance Plans, told me privately that that's exactly what the companies will do if regulations cut into their profits.

- pure conjecture based on an unnamed source

Thus, costs under Obamacare will almost certainly rise even faster than at present.

- this would be a platitude if it just said "continued to rise," but its stating "rise even faster" makes in pure conjecture.

No reform can work well or very long if its costs are unsustainable.

- pure platitude; also, just exactly what does it mean "can work?"

In fact, it is unlikely that Obamacare will ever be fully implemented as it stands

- I can’t make out if this is pure conjecture or a platitude --- if anyone can first translate what “fully implemented as it stands” means or if any legislation since the country began has met a similar benchmark, i.e. she's essentially presenting a pretty safe (but meaningless) bet

If Romney is elected, with a Republican Congress, it will be quickly overturned. If Obama is re-elected (and I hope he is, despite my disappointment in his health plan), it will come apart more slowly. But unravel it will, as costs rise and it becomes clear that there are still tens of millions of Americans priced out of the system.

- pure conjecture on many different levels

Here's how the unraveling will look:

Many of the uninsured who are subject to the mandate to purchase private insurance will choose to pay the penalty/tax instead. That will lead the insurance companies to raise their premiums, demand that the penalties be greater, or both.

- again, nothing in there but conjecture

Deductibles and co-payments will increase to the point that many people will have insurance they can't afford to use. (This is the case in Massachusetts.)

- pure conjecture for the national level and I believe outright incorrect for Massachusetts (Mass. has the highest % population coverage of any state in the Union), but certainly not supported by any data or references in her statement

Many employers will simply stop offering health insurance, since our high unemployment means workers no longer have the leverage to demand it, or they will stop insuring dependents (thus avoiding having to cover grown children to age 26).

- again, pure conjecture

In addition, because insurers have a strong financial incentive to evade the new regulations requiring them to take all comers, it will take a huge bureaucracy to monitor them.

- pure conjecture, but also is she talking about the huge bureaucracies that are already in place or what may be added as a result.


Bottom line: I found one fact in this entire piece and that was a positive attribute of Obamacare. The rest is platitudes and conjecture leaning toward fear mongering that might even make some t-baggers blush (well, maybe not that extreme )

There is also nothing here about what would be a viable alternative that could offer more certainty that all these fears will not come about .... and the key word is viable as in having something better that a political snowball's chance in hell.

Like I said, there will be more of this continued bashing, but it will wither away eventually. The people that are really into effecting real change are going to start seeing tremendous opportunities to work within the new paradigms of state/regional exchanges (hopefully get public options if not single payer) as well a ton of more money in the system. They will also gravitate to making those incremental changes at the national level that will bring progress in more subtle but important ways (expanding now-in-place subsidies). Perhaps the real busy beavers will even turn their focus to where the real cost increases in health care exist now that it will be less confused by folks saying its because of the insured having to pick up the tab for the uninsured or due to insurers overhead costs (including profits) which is limited to 15% of the premiums they collect or else they have to rebate back to the insured. Once the busy beavers of the organizations/blogs leave, the bashing is going to be left in the hands of those people that don’t garner much attention.

ACA will not change this:

Originally Posted by Deb C

ACA will not change this:

I'm not so sure about that.

As I noted above, the ACA’s Medical Loss Ratio provision is set at 85% for the Group market and 80% for the Individual market. That means ALL administrative costs including salaries and profits can be no more than 15% or 20% of the insurance premiums. That includes the CEO pay. The shareholders and the board will be in direct competition with the CEOs within those caps.

There is nothing like these caps in any other sector. The banks and auto manufacturers came close to having such caps, at least the ones that recieved federal bailout funds, but that is now long gone. The insurance CEOs pay is not out of line with the pay of these other sectors' CEOs. I have a feeling that is going to change and not in a benefical way for the insurance CEOs.

We'll see.

Playwrite:

We're in a Fourth Turning. Don't assume that the limits of what's politically possible at the present moment will remain so for the next decade and a half. In the end, a single payer system is the only thing that will work. In the end, that's what we'll have. The Supreme Court's decision upholding Obamacare has delayed that for a bit, because this creaky thing will certainly work better than the status quo ante, but it will come.

Originally Posted by Brian Rush

Playwrite:

We're in a Fourth Turning. Don't assume that the limits of what's politically possible at the present moment will remain so for the next decade and a half. In the end, a single payer system is the only thing that will work. In the end, that's what we'll have. The Supreme Court's decision upholding Obamacare has delayed that for a bit, because this creaky thing will certainly work better than the status quo ante, but it will come.

Completely agree. The issue is how we get there.

I don't think it’s going to come from some de novo attempt at national legislation that would make the ACA effort seem puny. I think the vast majority of folks that worked hard to make the ACA change not only want to see what will now happen with what they have accomplished but they are also too tired out, if not bored, with taking this through the irrational, if not insane, gauntlet that now represents the Right in this country.

Instead, it will come from building upon what is now the law. The tactics will be about getting public options into state and regional exchanges, making the Medicaid expansion to 17 million people in every State regardless how Red, building on the now-existing subsidy structure, and possible lowering the age of Medicare coverage (once everyone adopts MMT reality – okay this last one might be a stretch ).

A big fork in the road was taken. One can spend their days looking longingly back (or, hoping the road eventually circles back) to that fork. I personally think that’s futile. There's a whole hell of a lot more forks up ahead, opportunities in fact, that are going to have real impacts, life and death, on 10s of millions of people. I think that's where one's attention needs to go if truly interested in making progress.

I think I prefer the show about nothing to the tax on nothing.

Happy 4th!

http://www.youtube.com/watch?v=D_bG1...layer_embedded

Only in America!

But the striking down of the Medicaid expansion may have dealt ObamaCare an even more serious blow than the invalidation of the individual mandate would have - a fact that seems to be getting glossed over by most (but not all) observers on both sides in the debate.

So who really did "win" here?

Originally Posted by '58 Flat

But the striking down of the Medicaid expansion may have dealt ObamaCare an even more serious blow than the invalidation of the individual mandate would have - a fact that seems to be getting glossed over by most (but not all) observers on both sides in the debate.

So who really did "win" here?

While the ACA appears to help a bit, it doesn't change the big picture of health care in our country.

"Under half of all US health spending is by private companies — 46.9%. But it has the highest rate for health insurance in the world — 67.8% of all private spending. Which means the rest comes from out of pocket expenses, ie paying for health as you go."

The Health Spending Map of the World
July 3, 2012
by Theresa Riley

Everybody knows that the United States spends more money on health care than any other country. But how much exactly?

Over the weekend, the UK Guardian posted this interactive map (click to interact) that compares how much each country spends on health care. Find out how the United States’ spending stacks up against other Western nations and the world.

The accompanying article looks at some of the data more closely and observes:

“We took these statistics from the World Health Organisation, which measure spending and medical infrastructure in nearly 200 countries across the globe. They show huge variations in health funding, depending on where you live, although for most countries, people have to pay for healthcare direct…

The US has the highest health spending in the world — equivalent to 17.9% of its gross domestic product (GDP), or $8,362 per person. And it’s not all private — government spending is at $4,437 per person, only behind Luxembourg, Monaco and Norway.

http://billmoyers.com/2012/07/03/the...-of-the-world/

Originally Posted by '58 Flat

But the striking down of the Medicaid expansion may have dealt ObamaCare an even more serious blow than the invalidation of the individual mandate would have - a fact that seems to be getting glossed over by most (but not all) observers on both sides in the debate.

So who really did "win" here?

I don't think this is being glossed over; it's become the prime topic of discussion (regardless of Romney's flip flopping on whether the mandate is a tax or not).

Klein is on top of this more than most and has a great graphic showing how the poor, mostly in Red states, are getting screwed out of Medicaid right now by having incomes while way below the poverty level still don’t qualifying in these States’ -

http://www.washingtonpost.com/blogs/...-in-one-chart/




These are the folks that the Medicaid expansion was suppose to help with the Feds picking up the entire tab for the first 3 years and 90% of the tab afterwards.

CA and Minnesota and a couple other states have already started their programs which will result in millions being insured. My guess is about half of these 33 states on the chart will readily sign-up but its going to be a fight in the other 15 or so. Also, you can see that getting coverage in TX is a lot more important that getting coverage in SC. In TX, this might be the straw, combined with demographic change, that breaks the back of TX remaining Red - not by 2012 but very possible by 2016 (all other things being equal); that could hold for Florida, Arizona and a few others. Just more wood on the fire that 2012 may be the Right's last gasp.


The GOP governors threatening to do this are throwing some of their poorest citizens under the bus solely to placate their t-baggers' ideological stupidity - they are all basically sociopaths. Fighting these sociopaths in each of their states is the REAL work of true Progressives, and likely a lot more rewarding than continuing to blog, if not whine, on and on about not getting single payer at the national level.

Now that the individual mandate has been upheld we should look at what the cost will be--and who has to pay it.

Originally Posted by MPRNews

The Supreme Court's decision to uphold the individual mandate requiring Americans to have health insurance or pay a penalty has angered some people and frightened others.

The mandate and the penalty are designed to prod younger, healthier people to buy insurance. That will help pay the cost of new insurance reforms, such as a ban on discriminating against people with pre-existing conditions...

...Research shows that when people save their own cash and skip on insurance it can get expensive for taxpayers. When the uninsured do need medical care, taxpayers foot most of the bill.

One study finds so-called uncompensated medical care cost the nation $57 billion in 2008. Most of that, about $43 billion, was paid by federal, state and local governments...

But the non-partisan Kaiser Family Foundation said that when the mandate and penalty take effect in 2014, paying the fine will be cheaper than buying health insurance for virtually everyone who does not have coverage. The penalties grow with time and reach their maximum in 2016.

At that point it becomes cheaper to buy insurance at some, but not all income levels: for an individual at $17,000 a year and up; a family of four, at $40,000.

So if the fine is cheaper than buying insurance how effective will it be?

Kaiser's Larry Levitt said people's decisions will come down to more than just dollars and cents. The penalty does not buy anything, but insurance can buy the peace of mind of having protection against huge medical bills. Today, Levitt said a family of four making $40,000, would have to pay $12,000 a year to get health insurance. But under the federal health care law, that same family would get over $10,000 in subsidies, reducing their cost to $2,000, which is about the same cost as the penalty.
Larger view
Ruling reaction

"So yes, they could pay the penalty, but [if they spent the money on health coverage] they'd be getting a $12,000 insurance policy for roughly the same price," Leavitt said.

He said the number of people who decide that paying the penalty is a better deal is anyone's guess.

The penalty does not apply to all Americans. There are exemptions for people who have so little income that they don't file taxes, members of certain religious groups and American Indian tribes.

Even though the mandate is unpopular, it's likely to be an issue for only 6 percent of Americans.

The Urban Institute projects that if the mandate and penalty were in effect today, 94 percent of Americans would not have to choose between buying health insurance or paying a fine. That's because most already have access to insurance through their employer or public programs.

Six percent of the population will be affected if the program is not repealed and the cost may amount to about 2k a year for a family of 4 or about $500 per person with the subsidy.

It is likely that the Republicans are going to try to pitch the mandate as the biggest tax of all time. In fact, I've heard blurbs along those lines already.
It will be a test of the voter education effectiveness of the Democrats to press the facts well enough that many poor citizens won't vote against their own self interest out of fear this November.

Yes, Obamacare as they call it isn't perfect, but it's the closest thing to a true fix that we're likely to see until the next 2T give us another social moment with its inherent openness to change and reform.