ObamaCare’s impact on health costs.
WASHINGTON — House Republicans on Tuesday will unveil a proposed budget for 2016 that partly privatizes Medicare, turns Medicaid into block grants to the states, repeals the Affordable Care Act and reaches balance in 10 years, challenging Republicans in Congress to make good on their promises to deeply cut federal spending.
The House proposal leans heavily on the policy prescriptions that Representative Paul D. Ryan of Wisconsin outlined when he was budget chairman, according to senior House Republican aides and members of Congress who were not authorized to speak in advance of the official release.
With the Senate now also in Republican hands, this year’s proposal is more politically salient than in years past, especially for Republican senators facing re-election in Democratic or swing states like Pennsylvania, Wisconsin, Illinois and New Hampshire, and for potential Republican presidential candidates.
If you like your health insurance plan, you actually might have been able to keep it this year.
Fewer than 1 million Americans had their health insurance plans canceled for 2015 for noncompliance with Obamacare rules, according to a report by the Urban Institute and Robert Wood Johnson Foundation.
The report, which called that number “quite small,” suggests that in the latest enrollment season there was relatively little disruption of either the individual or job-based insurance market due to plans not meeting Affordable Care Act-related regulations.
Those rules set certain minimum standards for coverage, including prescriptions, maternity care and mental health treatment, which were not required in plans prior to the ACA’s enactment.
Last week’s Supreme Court arguments on ObamaCare struck me as a bit irrelevant, and not just because the case won’t impact New York.
The case is about whether federal subsidies are actually legal in states that didn’t set up their own insurance exchanges — but the truth is, ObamaCare is a bad deal even with the subsidies.
Down here in the medical trenches, the harsh reality of the Affordable Care Act continues to play out.
One of the most anticipated cases of the Supreme Court’s 2014-2015 term is King v. Burwell. In it, the Supreme Court is confronted with what should be a straightforward question of statutory interpretation about the scope of subsidies available under the Affordable Care Act (ACA). Section 1311 of the ACA states that “each state shall, not later than January 1, 2014, establish an American Health Benefit Exchange.” Another part of the law, section 1321, then qualifies that apparently absolute duty by providing that if the state does not “elect” to establish that exchange by January 1, 2014, or if it otherwise fails to meet the federal requirements for an exchange, “the Secretary [of HHS] shall . . . establish and operate such exchange within the state.”
The question of whether a state establishes this exchange determines far more than where individuals can buy their health care coverage. It also determines whether any purchaser of health insurance is entitled to a tax credit against his or her cost of coverage, as that subsidy is limited to taxpayers who are enrolled in a qualifying plan “through an Exchange established by the state” under Section 1311. Internal Revenue Service regulations interpreted the ACA requirement so that its tax subsidies were available to all individuals whether they enrolled in an exchange established by the state or by HHS when the state elected or failed to do so. The plaintiffs’ challenge to the regulation was in essence that the plain language of the ACA precluded the IRS from expanding the scope of the subsidy by this sleight of hand. King would have been an open-and-shut victory for the plaintiffs if the disputed interpretation had been some run-of-the-mill tax provision. But 36 states did not establish these exchanges because they wanted to guarantee their citizens the statutory tax breaks.
Liberals would rather pretend that conservative arguments don’t exist—at least it feels that way, sometimes. But on the eve of King v. Burwell, that is exactly what’s happening. Recognizing the significance that constitutional federalism could come to bear in interpreting the Affordable Care Act’s provisions for health insurance exchanges, some of the Administration’s defenders have begun to argue that their opponents have not even attempted to make a federalism argument in support of their challenge.
Congress is busily making plans for legislative action should the latest challenge to Obamacare prevail in the Supreme Court.
On Wednesday, the justices will hear arguments in King v. Burwell to decide whether the IRS had the authority to write a rule authorizing subsidies to go to millions of people in the 37 states with federal exchanges.
The plaintiffs say the language of the law is clear: Subsidies are allowed in “an Exchange established by the State under [section] 1311of the Patient Protection and Affordable Care Act.” It doesn’t just say this once, but nine times in various linguistic forms.
That is the point that MIT economist Jonathan Gruber made when he famously said: “If you’re a state, and you don’t set up an exchange, that means your citizens don’t get their tax credits.”
The day of reckoning for President Obama’s lawless rollout of Obamacare finally will arrive this week when the Supreme Court hears oral arguments in King v. Burwell. Americans who are interested in the rule of law should hope that when the SCOTUS hands down its decision–most likely on the very last day of the term this June–it will rule to enforce the law that was actually written, not the law the IRS wishes had been written. But those like me who are interested in good health policy are looking forward to an important side-benefit of such a principled decision. It finally may give us a crude market test for a poorly conceived and badly marketed product that so far has survived only because it has a federally enforced monopoly behind it.
By our count at the Galen Institute, more than 49 significant changes already have been made to the Patient Protection and Affordable Care Act: at least 30 that President Obama has made unilaterally, 17 that Congress has passed and the president has signed, and 2 by the Supreme Court.
As we approach oral argument this week at the Supreme Court in the King v. Burwell case, critics of the latest legal challenge to an Affordable Care Act provision are predicting a disaster of biblical proportions if the Court overturns an IRS rule and declares as illegal the current insurance subsidies for coverage in health exchanges established by the federal government.
This endless loop of major media reporting seems to be taking its cues from the original Ghostbusters movie script. “Fire and brimstone coming down from the skies! Rivers and seas boiling! Forty years of darkness! The dead rising from the grave! Human sacrifice! Dogs and cats, living together! Mass hysteria!” But only the “mass hysteria” part may be accurate for some of those news and commentary outlets.