The Obamacare Outcome Matrix

Tyler Durden's picture

With the Supreme Court likely to announce its decision on the constitutionality of Health Care Reform Law this Thursday, BofA outlines five possible scenarios and their potential impact across the healthcare sectors. They base the likelihood of their scenarios on a review of the March oral arguments, previous circuit court decisions, as well as surveys of legal experts and former Supreme Court clerks. Everything you need to know about the possible outcomes and actions to take.


Supreme Court upholds the Individual Mandate: In this case, the Court would uphold the Affordable Care Act, and the next catalyst would be the upcoming elections. In addition, there remain questions as to whether the health reform law can be implemented by 2014 as many states have delayed implementation awaiting the court’s decision, and the federal government may not be able to implement exchanges in all of those states. This scenario would be positive for the hospital sector, in our view.

Supreme Court strikes the Individual Mandate, but, upholds the rest of the law: In this scenario, the Court would strike the individual mandate, but, keep in place the rest of the law, including all of the health insurance provisions. We would view this scenario negatively for the managed care sector.

Supreme Court strikes the Individual Mandate, along with related health insurance provisions (guaranteed issue, community rating, etc.): In this scenario, the Court would strike the individual mandate, along with several related health insurance provisions – particularly guaranteed issue and community rating provisions, as the Obama administration also recommended striking these down if the mandate were struck. This scenario would result in fewer covered lives (16 million vs. 32 million) according to the Congressional Budget Office, but, would maintain the Medicare payment reforms and payment reduction provisions.

Supreme Court strikes down the entire Health Care Law: In this scenario, the court would find the individual mandate unconstitutional, and not severable. This scenario would be a negative for hospitals, in our view, but generally viewed positively for managed care (other than Medicaid managed care).

Supreme Court strikes down the Medicaid expansion: In this scenario, the Court finds that the mandated expansion of Medicaid to all beneficiaries below 133% of poverty is coercive to the states, but, would leave a significant hole in coverage for low income individuals, that would need to be addressed by Congress.


Source: Bank Of America Merrill Lynch

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Whoa Dammit's picture

Forcing people to pay for health insurance in the middle of a depression when they already are strugling to pay for food, clothing, and whatever shelter the bankers have left them, may just be the final straw.

GMadScientist's picture

Hey why do all the rows and columns say: "Insurance Company Fucks You In Your Ass For a Profit"?

geoffb's picture

Dammit now I have to mix another drink. LOL.

GMadScientist's picture

Spilled drink fallacy.

I don't know where I went to deserve the Fitness Singles banner ad, but the quarter-bouncable ass is appreciated.

Conrad Murray's picture

Because you only read Commienese. Still, better than "Government puts gun to head of 50% of the population to extort tax on unbacked fiat in order to support the largesse of the other 50%"

GMadScientist's picture

You prefer being screwed by one segment of society more than another. Ya can't please some freaks.

The insurance company will overcharge you to cover the payout for your 400lb smoking neighbor too; only you don't have a seat on their board with which to hoist them overboard. G'head and say you'll "go to another company"...and then try it in Alabama.

Let's just say I'd prefer not to have any guns to my head, not just a choice of trigger fingers.


HungrySeagull's picture

Oh the Bleeding? Never mind that, we have more blood.

It will cost you to have it provided.

kito's picture

BOA should love obamacare, fits right up there with BANKSTERCARE.............tyler you do realize by giving space to these bank clown analysts-- who cant see past their nose and who are either wrong when they make a specific call, or vague when they throw out 10 different outcomes of how europe will fail--you are giving them credibility. you partly perpetuate the very system that you rage at a loss as to why you post opinions/prognositcations from them. their very mindset is made up of ego driven deranged groupthink.  they are part and parcel of a dying matrix that has plagued this country for decades........there is no need to throw them a lifeline..............and that is exactly what you are doing every time you post their garbage in a manner that seems like gospel to the uninitiated......



Dr. Engali's picture

I've had many successful trades based on Tyler posting information from these clowns. More often than not I trade against them. Regardless it is information out there to diseminate , do with it what you will.

“If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself,
you will succumb in every battle”
Sun Tzu, The Art of War

kito's picture

disseminating and acknowledging their garbage without criticism gives credit to their garbage...........of course we all enjoy when tyler highlights their shortcomings, but there is no need to frame them as a legitimate voice in articles such as these............

One World Mafia's picture

Got this email from Ron Paul's Campaign for Liberty in April about how the fed govt is bribing states to sneak it thru:

Have you ever noticed that when the media is focused on something big going on in government, something else skulks under the radar?

By the time you learn about the other issue, it’s usually too late to stop it.

All eyes are on the Supreme Court right now, as the 50 states await a decision on the constitutionality of ObamaCare.

But something sinister is lurking behind the scenes. ObamaCare is being planned and developed in the states RIGHT NOW!

Health Insurance Exchanges are not a new concept in America. They were created in Utah and Massachusetts long before ObamaCare, and they have been costly and ineffective failures.

In order to institute the infamous “individual mandate,” ObamaCare bribes each state to set up what is known as a Health Insurance Exchange. Without a state-created exchange, the individual mandate cannot be enforced.

And once our state creates an exchange, it will remain in place - even if the mandate is overturned.

Regardless of what happens in court, our state should be fighting the implementation of ObamaCare at every turn.

We must oppose ObamaCare State Exchanges every step of the way, regardless of any court decision, because:

ObamaCare State Exchanges mean mandated, government-run health care.
Hundreds of millions of taxpayer dollars are being used to develop ObamaCare Exchanges. Your taxpayer dollars are being wasted, and you are footing the bill while they steal your freedoms.
There are strings attached to the bribe money. Accepting the money requires the state to submissively surrender sovereignty on all health care issues.
After the State Exchange is up and running, federal money will dry up - and states will have to pick up the tab. Your state taxes will have to be increased in order to pay for it!

Make no mistake, the federal government will control every aspect of your health care.

Yet, Governor Corbett claims that establishing a CorbettCare Exchange will protect Pennsylvania citizens from undue federal regulation. The opposite is actually true. Creation of the CorbettCare Exchange does great harm and forces onerous federal regulations on our state.

Governor Corbett is readily ceding state sovereignty to the central government, and relinquishing all authority on health care matters.

WhiskeyTangoFoxtrot's picture

All I have to say is this: pull up this article and do a ctrl + F for "Lynch Obama." Unfortunate tagging or Freudian slip, Tyler(s)?

francis_sawyer's picture

Can we start calling this thing what ity really is?


caimen garou's picture

where can I get the US handbook of laws ,rules ,and regulations! I have a hard time keeping up with this crap!

i_fly_me's picture

It used to be called "The Constitution."  Quaint, huh?

Conrad Murray's picture

For everyone other than Commies and slaves, it still is. Hang the traitors.

A Lunatic's picture

We already know it's unconstitutional so I fail to see the dilemma.



Edited to add:

Fuck you Obama.



Fuck you too Romney.

Dr. Engali's picture

The dilemma is that there are people on the supreme court who think the constitution is no longer applies in a" modern complex society" such as ours.

Mercury's picture

Questions would remain as to how to provide coverage for low income individuals below 133% of poverty.  Congress would need to address this issue.


Apparently we just assume now that "coverage" = actual medical attention and that the government (specifically the morons in congress who forced this abortion on us while exempting themselves) is the 'Easy' button for life's problems.

honestann's picture

If the law is upheld in any significant way, expect millions of people to LEAVE the USSA, following those of us who already left in the past few years because we are not willing to be slaves... period... end of story.

honestann's picture

Well, I prefer to keep my privacy intact, but to not totally avoid your question, my short list was chile, fiji, nz... in, ehhhh... alphabetic order.  I also considered nepal, iceland, mongolia and a few other oddball places.  Gotta give high marks to iceland for throwing the banksters and politicians out the window!  If it wasn't so damn cold!  Hmmm... maybe living next to some molten magma might work.

Personally I'm partial to water (ocean/lake), mountains (at least not flat), low population density, solitude/boonies, dry (low humidity), warm, and either has a relatively benevolent or restrained or limited government, or has a government that is poor and clueless (and therefore fairly restrained to screwing around only in populated areas).  For example, fiji is good because their "government" is like the keystone cops, hardly ever has anyone visit the tiny outlying islands much less islands that are home to one individual or tiny group (my kind of places).

Nowhere is perfect.  Only the least humid places in fiji (with mostly constant breeze) have tolerable levels of humidity for me.  I would never live near a city (which means "more than ~10,000 population" to me), so some countries that might not look great on the surface aren't so bad when you live in the extreme boonies of the andes, or on an island of your own (where 50km from the nearest large island by catamaran or light aircraft feels much more isolated than a quick 50km drive on a highway).

The 20 years before I escaped, I lived in Wailea, Maui, Hawaii.  That too was a tradeoff... one of the driest parts of Hawaii, but just barely within my humidity tolerance.  But it was pretty good as far as warm weather, warm ocean, gorgeous [albeit few] mountains (Haleakala), and for the first 10 years fairly "out of sight, out of mind" when it came to government and "regular folks".  Unfortunately, the housing bubble destroyed Maui, like so many other places (the prices went sky-high, but didn't fall back much in the crash --- a "no win scenario").

PS:  Just in case someone with a bit of savings and a shred of "can do" still exists, and happens to read this, I'll mention a project I can only do given one or two partners.  I found a spectacular ~60 acre island that I can purchase (yes, the whole island), surrounded by year-round warm water and living coral reefs, roughly 1.4km long by 0.4km wide, with a ridge that runs down the length and gets up to 80 meters altitude, and about 2km of pristine bright-white sand beach in 4 separate private sections.  I'd like to buy and develop it as follows: one side for "us" (the partners), then subdivide part of the other side for others to purchase 16 lots of roughly 1 acre each --- all literally on the beach.  The idea is to recoup everything we paid for the island and the "self-sufficiency" improvements we install to make the lots practical and attractive (solar-panels, wind-turbine, water-capture and filtration/purification, underground pipe to carry all this to the lots --- and our side too).  Then we can decide whether to establish 2 or 3 ultra-exclusive "executive vacation" properties on our side, each with its own private beach and/or our own digs, or whatever we choose.  I can't pull this off myself, but 1 or 2 more partners with $250K or more savings to invest, and we're off to the races --- and own our own island with zero property taxes!  No, I'm not saying where in public!  I've spend 100s if not 1000s of hours finding totally awesome properties, and this is one of my top 3 finds.

buzzsaw99's picture

the scotus is overstepping its authority by reviewing this law.

HungrySeagull's picture


It is CONGRESS and Executive that overstepped law. Thus Checks and Balances fall to SCOTUS to restore the proper balance for the PEOPLE as intended by the Founding Fathers.

My one fear is someday there will be 9 wussies on that Court who will go along with any namby pamby bullshit crap and override the people.

IT WAS THE STATES that sued on behalf of the People.

Rich Bagg's picture

Both parties want this stricken so it shall be.  Republicans for obvious reasons but Democrats too because they thought Single Payor was the solution.  Obama tried to make everyone happy and it backfired.



mvsjcl's picture

Get real. Like Obama sat in the Oval Office, rolled up his sleeves, licked the pencil tip, and penned this massive bill all by himself, motivated solely by altruism and a desire to "make everyone happy." If only.


This abortion of legislation was conceived by corporatist interests and hand delivered to his minions by the puppetmasters' lobbyists frontmen, who said "Here's our latest demands. Now get this passed, or else."

barroter's picture

Stick to your for profit providers, which constantly goes up. Enjoy the denials and run arounds from insurance. Believe in the free market which NEVER once has lowered the costs of health care.  Rejoice in the fact your yearly insurance premium probably has out pace your yearly mortgage payment.

Duke of Con Dao's picture

everyone seems to be harshing on Obama...

hey, I love a pile-on! here is a vid mash I did some years back

when Caldera was still in the Cabinet... and Rahm...

got some funny bits I think, esp the Air Force One scene...

and let's not forget the lovely Cat Power


JLee2027's picture

It better be dead. If not, we are moving along similiar paths of 1760-1774 when Parliment refused to listen to the People.

OneTinSoldier66's picture

Here's a scenario.


If they uphold it, and try to come for what little bit of money I manage to eek out in this hell hole of oppression...


They'll never take me alive!

PulpCutter's picture

The individual mandate was orignally a Republican idea - before a Democrat put it into law, then the Republicans decided it was unconstitutional.  Even Fox News figured this one out:


Republicans Hatched Idea for Obama's Health Insurance Mandate

Republicans were for President Obama's requirement that Americans get health insurance before they were against it.

The obligation in the new health care law is a Republican idea that's been around at least two decades. It was once trumpeted as an alternative to Bill and Hillary Clinton's failed health care overhaul in the 1990s. These days, Republicans call it government overreach.

Mitt Romney, weighing another run for the Republican presidential nomination, signed such a requirement into law at the state level as Massachusetts governor in 2006. At the time, Romney defended it as "a personal responsibility principle"


Other facts about healthcare that you won't hear on Fox News anymore:

If we dropped out healthcare spending to the level of France, 11.8% GDP, we'd save $850 billion/year.  France's system is govt-run, still has housecalls(!), and has the best overall health outcomes in the world.

Medicare administrative costs, per dollar of care delivered, are 40% those of the private insurers. 

In the midst of a deep economic recession, America's health insurance companies increased their profits by 56 percent in 2009, a year that saw 2.7 million people lose their private coverage.

JLee2027's picture

""In the early 1970s, President Richard Nixon favored a mandate that employers provide insurance."""

That's a real stretch to claim that's the ""origin"" of the idea of a Government Mandate. In fact, to make that claim I think you fell over a cliff.

PulpCutter's picture

Are you claiming that the mandate wasn't the mainline GOP counter-proposal to HillaryCare? If so, you need to check your facts.

Heritage (GOP "thinktank") proposed it in 1989.  Here's the link below.  Even FoxNews got this one right - are you more clueless than FoxNews?  Is that even possible?

 The Consumer Choice and Health Security Act, sponsored by Sen Don Rickles (R-OK) and 24 GOP Senate co-sponsors in response to Hillary's healthplan, contained the individual mandate as a central feature. 


Sathington Willougby's picture


Ha ha, democrat vs republican.  Why don't you frenemies get a room?  Then you can talk about stealing all night long.

HungrySeagull's picture

It matters not.

I would like to see a stand made on the "Checks and Balances" from the SCOUS for all our sakes.

The damn law is unconstitutional and they know it.

tahoebumsmith's picture

When Obama circumvented the Senate and rammed this bill through in 2010 there were 23 million Americans that were in need of healthcare. Two years later that number has grown to 32 million, an increase of nearly 30%? If it was going to cost taxpayers 1 Trillion two years ago, how much is it going to cost us now? The cost of healthcare has already risen nearly 20% since the bill was passed in March 2010. Add another 9 million people to the dole and my guess is heathcare costs will continue to bankrupt Americans.

PulpCutter's picture

"When Obama circumvented the Senate and rammed this bill through..."

God, you're a numbnuts.  Republican presidents have used the budget reconciliation process to 'ram' bills past the Senate fillibuster more often than Democratic presidents have.

Bush used it three times to pass his deficit-exploding tax cuts.  Here's one your GOP idiot "think tanks", the Heritage Foundation, claiming Bush's 2001 tax cut would grow the economy enough that the federal debt would be retired by 2010.  How'd that work out for you?

The Economic Impact of President Bush's Tax Relief Plan

By and
April 27, 2001


President George W. Bush and Congress are currently engaged in a major debate on the issues of reducing the record-high tax burden and addressing a number of problems in the tax code. The President has proposed to lower marginal income tax rates, reduce the marriage penalty, increase the child tax credit, and phase out the estate tax. The House has passed three tax relief bills: H.R. 3 to reduce marginal income tax rates, H.R. 6 to reduce the marriage penalty and increase the child tax credit, and H.R. 8 to phase out the estate tax.1 The Senate has not yet acted on any tax relief bill.

One element of the debate over President Bush's tax plan concerns how it will affect household and government budgets as well as the U.S. economy.2 To assess the plan's economic and budgetary effects and to help frame this debate, analysts in The Heritage Foundation Center for Data Analysis (CDA) conducted a dynamic simulation of the proposals in the President's tax relief plan. The final results show that the Bush plan would significantly increase economic growth and family income while substantially reducing federal debt.3 For example:

  • Under President Bush's plan, an average family of four's inflation-adjusted disposable income would increase by $4,544 in fiscal year (FY) 2011, and the national debt would effectively be paid off by FY 2010.4
  • The net tax revenue reduction, after accounting for the larger tax base that would result from higher employment and faster economic growth under the Bush plan, is $1.1 trillion from FY 2002 to FY 2011, 33.4 percent less than conventional static estimates.
CABill's picture

Step 1: 

Greece fixes high unemployment by hiring government employees and expanding bureaucracies.

Greece pays for idle government employees by raising taxes.

Taxed businesess hire fewer employees, and start shutting down.  

Unemployment rises.  

Greece creates more government programs and borrows from central bank.  

Greece causes the country to go bankrupt.

Step 2: Replace the word Greece with Obama

PulpCutter's picture

Ditch the trite lies; time for facts

Clinton: lowest number of federal employees since Eisenhower

GW Bush: biggest increase in the number of federal employees in history

Catullus's picture

That's because Clinton "privatized" the federal workforce by outsourcing most of the jobs to contractors.  Fact.

Now there are government contractors who get contracts only so they can subcontract out the work to someone else for cheaper.  Fact.

The counties surrounding Washington DC have the highest median income in the country.  There is no major manufacturing, service, or technology industry in Washington DC.  Facts.

Sathington Willougby's picture


Taking a man's wages by force is stealing, fact.

PulpCutter's picture

"That's because Clinton "privatized" the federal workforce by outsourcing most of the jobs to contractors.  Fact."

In what alternate universe did that happen? Got a bridge for sale, too? 

Maybe you're confusing Clinton with Dubya, where so many of the personnel in Iraq were 150K/yr private contractors.  Fact.

Bolweevil's picture

"Keep your laws out if my uterus!" or something like that

Catullus's picture

So if this is upheld, Hospitals benefit from the "32 million" (it's more like 8) who now become insured and greater utilitization.  If the mandate is taken away, hospitals don't benefit because the forced price controls (I'm sorry, we're calling those "cost controls" now) would still be enforced and not as many people would be insured.

So, good = more people at forced lower prices vs bad = fewer people at lower prices. 

All of the other things matrixed here are higher order on the medical care supply chain.  Ultimately the hospital is on the retail end of health care services.  And they're not that profitable.  If you haven't noticed the waves of hospital consolidations across the country, it's not because they're swimming in cash and excess capacity.  Never mind that most of the states are bankrupt and put the Medicaid bills in arrears by mid-fiscal year for the past 4, increasing Medicaid access should fix that (haha).

But don't get your hopes up ever for the Supreme Court to strike anything the Federal Government does down.  They work for the Federal Government, there have very few occassions in history when a group of lawyers appointed for life has told their employer that they're not allowed to do something.

johnjkiii's picture

I'm sitting here in England where the doctors went on strike for higher pensions and so numerous bureaucratically delayed operations had to be put off - yet again. (Not hip to need a hip) Where the bus drivers stage 1 day strikes because the guv'mint won't give them a £500 bonus for working normal shifts during the olympics and I realize I am getting used to what Obammy will do for America. It helps me understand the give-a-shit attitude of the Brits toward work & success. Obammy will give us all the goodies we all deserve and nobody will hear the giant toilet flush before we all go down the shitter.


Sathington Willougby's picture


Yeah, so, isn't it getting near lunch time?