“The Commonwealth Fund has a new study out on Obamacare enrollment, estimating that about 9.5 million people gained coverage through Medicaid and the exchanges; this is roughly in line with some previous estimates but perhaps slightly more encouraging for the law’s supporters. Jonathan Cohn uses the estimate to declare that the law is meeting expectations in covering the uninsured:
… The Congressional Budget Office predicted that, one year into full implementation, Obamacare would reduce the the number of Americans without insurance by 12 million. That included the young adults who got insurance before 2014, by signing onto their parents’ plans. There’s been some controversy over exactly how many more young people are insured because of that new option, but the best estimates I’ve seen place the number somewhere between 1 and 2.5 million. Add that number to the 9.5 million from the Commonwealth survey, and you’re close or equal to the CBO projections.
Of course, the Commonwealth survey has a hefty margin of error and the CBO projections, revised to take account of the early technological problems on Obamacare websites, were never that scientific. But the figures seem to be in the same ballpark. That’s what matters.
In broad strokes, this is plausible: Obamacare has stabilized, it’s insuring substantial numbers of people, the disaster scenarios have been averted and most people getting coverage seem reasonably happy with it. I would only offer the caveat that when Cohn says “in the same ballpark,” he means “in the same ballpark, but probably lower than what was hoped for, which in turn was lower than what was originally projected.””
“It was an important step forward for Republicans. They could have continued to deploy their anti-spending fervor against the discretionary side of the budget rather than taking on the larger, faster-growing, and politically trickier entitlements. They could, that is, have adopted a posture rather than a policy. Medicare reform was a sign the party was interested in governing again. Control of entitlements is after all a fiscal precondition for reform conservatism, or any other serious agenda.
Yet no larger agenda followed the Medicare initiative. Republicans’ advocacy of Medicare reform did not sink them, as Democrats had hoped, but neither did it supply an answer to voters’ concerns about the status of the American dream. And even as Ryan’s boldness got him a spot on the Republican ticket, it seems to have exhausted the appetite for innovation on the part of his colleagues. The Republicans were still narrowly focused on cutting spending.
A few Republicans started to adopt reformist themes following the 2012 election. Just a few weeks after it, Ryan criticized Republicans (though not his running mate) for having too little to say to Americans who do not run a business. Governor Bobby Jindal of Louisiana took aim at the Republicans’ tendency to identify, and be identified, exclusively with the rich. Senator Marco Rubio of Florida touted a proposal to address Americans’ anxieties about the rising cost and uncertain payoff of college.”
“Supporters of ObamaCare are nervously awaiting a decision by the D.C. Court of Appeals that could have even more dramatic consequences for the law’s ability to function than the Supreme Court’s religious liberty decisions issued last week.
Judge Thomas B. Griffith presided in March over arguments in one of the four cases – Halbig v. Burwell – challenging the Obama administration’s decision that subsidies for health insurance can flow through federal as well as state exchanges.
The Affordable Care Act says that health insurance subsidies are available only “through an exchange Established by the State.” The IRS, however, interpreted the statute to mean that the subsidies also could be distributed in the now 36 states where the federal government is operating exchanges.
During oral arguments, Judge A. Raymond Randolph indicated he felt the statute was quite clear in repeating “seven times” in that section that the subsidies are available only if the state sets up its own exchange.”
“The Supreme Court today rang a victory bell for religious freedom as it ruled 5-4 that “HHS’s contraceptive mandate substantially burdens the exercise of religion” of three closely held companies – Hobby Lobby, Conestoga Wood Specialties, and Mardel.
The companies objected to the Obama administration’s mandate that they must provide, at no cost to their employees, coverage for products that can terminate life in the womb, violating their religious beliefs.”
“Supporters of ObamaCare acknowledge it will have some unintended consequences. Yet surprisingly little attention has been focused on the law’s most problematic provision: government subsidies to help individuals and families purchase health insurance.”
During the yearlong debate over the president’s health care plan, critics repeatedly warned of the dangers of centralizing so much power in the federal government. It would, they argued, lead to stifling bureaucracy, irrational one-size-fits-all decisions, and needlessly burdensome regulatory hassles and requirements. Worst of all, it would introduce politics into everything. Instead of focusing on what’s best over the long run for patients, consumers, and those paying the health care bills, politicians would use their newfound power to increase their leverage still further, to win political fights, and to enhance their images as powerbrokers dispensing benefits to needy and otherwise helpless constituents.
President Obama and his allies called this kind of criticism overblown hyperventilation from opponents determined to say no to everything.
Well, after just six months of implementation, it’s clear that even ObamaCare’s fiercest critics underestimated just how badly and how quickly the new law would distort decision-making in American health care.
The latest sign of how bad things are — and how bad they will get — came in the form of a New York Times story indicating that the Department of Health and Human Services (HHS) has issued waivers to dozens of employers and insurers to allow them to avoid, for the next year at least, some of ObamaCare’s costly new insurance requirements. According to the Times, the HHS waivers have gone to companies such as McDonald’s and Jack in the Box, as well as to selected health insurers and union-sponsored plans. These companies and plan sponsors were warning HHS that the new health law’s ill-advised and inflexible burdens would force them to drop coverage altogether — a fact that the legislation’s critics had predicted before passage, but that the administration denied. All totaled, about one million Americans are enrolled in plans that are now exempt from the costly new requirements; it seems likely that number will only grow in coming weeks with more HHS waivers.
The Obama administration is trying to have it both ways here. On the one hand, out on the campaign trail, the administration is touting these new insurance requirements as sacrosanct protections for a long-suffering public. Indeed, the president and HHS Secretary Kathleen Sebelius have dared Republicans to pursue repeal because that would mean stripping Americans of the new insurance rules that Democrats believe are popular with voters. At the same time, however, these protections apparently aren’t so important that they can’t be unilaterally stripped away by the Obama administration itself for whole segments of the currently-insured population, based on what suits the administration’s political interests. And it’s abundantly clear that what the administration wants to avoid at all costs are headlines between now and the midterm election confirming what the public already suspects: that these new requirements are going to have the perverse effect of prompting large numbers of employers and insurers to leave the health insurance marketplace, and thus decrease choice and increase the number of uninsured Americans. Some argue that the administration’s waivers are a sign of pragmatic flexibility. But what they really show is that the administration has the power to treat people and companies differently based on political expediency. For every McDonald’s and politically-connected union plan, there are scores of others with less political clout that will either drop their coverage with little fanfare or be forced to scale back their other operations — and perhaps hire few workers — based on the costs imposed by the regulations. As my colleague Yuval Levin has noted, the powerful and politically connected get their way, while everyone else is forced to fall into line.
It’s obvious from the recent behavior of Secretary Sebelius that HHS believes it is now calling the shots in health care. In September, she issued a threat to health insurers that was astonishing. Some insurers had the audacity to note in their rate filings with various states that premium increases for next year were due in part to implementation of some of the much-touted insurance requirements favored by the administration. It’s common sense that imposition of new, mandatory coverage of certain medical bills will increase premiums by some amount. These insurers were just telling it like it is. But that was apparently too much for an administration determined to peddle the fictional narrative that somehow benefits can be bestowed by the government at no cost to anyone. And so the new health care emperor issued a warning: any insurer caught telling the truth like this again in public would be barred from participating in the government-managed marketplace set to become operational in 2014.
This is no idle threat. For many insurers, if they can’t sell to the large number of customers who are expected to get their coverage in the new government-managed “exchanges,” they will go out of business. So, in a very real sense, the HHS Secretary is threatening the livelihood of working Americans, all to advance the partisan political objectives of the administration.
It’s hard to overstate how damaging this kind of heavy-handed behavior will be to the effective and efficient operation of American health care. The federal government has made it abundantly clear that it is now the choke point for all important health care decisions. No one can do anything of consequence if it doesn’t conform to a grand federal plan. States don’t control insurance markets anymore. Employers no longer really run their own employee benefit plans. Insurers are rapidly becoming nothing more than public utilities that effectively work for the Department of Health and Human Services. And hospital systems and physician groups no longer can decide for themselves what constitutes effective medical care.
The result will be stagnation and inertia. If the government wants to run everything, all the other players are going to stand back and let them try. But that will be a disaster for patient care. A distant, centralized government simply cannot micromanage a health system for 300 million people well. It will be clumsy, and slow to adapt. Innovation will cease to occur. There will be no risk-taking or organizational initiative. Any changes will have to be initiated from Washington, which means almost everything will simply get frozen in place.
The only winners in all of this are the politicians who crave power. They now have much more of it to wield, and they have already shown they will do so to serve their own interests, not those of patients.
“Mr. Obama also said repeatedly that if you like your current coverage, you can keep it. According to an analysis by John Goodman of the National Center for Policy Analysis, that won’t be true for between 87 million and 117 million Americans. Either their employer will stop providing insurance, or they’ll see benefits go down and co-pays rise as insurers and employers wrestle with the law’s mandates.”
ObamaCare’s mandates will cost many low-income workers their employer-based insurance coverage. The Administration promises to waive the regulations, but that merely further politicizes health care decisions and centralizes more power in Washington. “Any such criticism now triggers an autonomic reflex among administration spokesmen where they regurgitate the lines, ‘Americans have seen what happens when insurance companies have free rein. The Affordable Care Act ends insurance companies’ worst abuses.’ As if giving bureaucrats free rein to engage in abusive government practices is an improvement.”
“The Patient Protection and Affordable Care Act, a.k.a. ObamaCare, is to the law of unintended consequences what Newton’s apple was to the law of gravity: the illustration that bonks us on the head with its obviousness. Practically every week since its passage has added a new dimension of mirth to Nancy Pelosi’s punchline for the ages, that we had to pass the bill to find out what is in it. Out of the mouths of babes and clueless politicians . . .”
HHS Secretary Kathleen Sebelius threatened insurance companies to stop telling customers that higher prices can be blamed on ObamaCare. “But there is every reason to think this alleged libel is true. The health care law requires health insurers to do all sorts of things, such as eliminate lifetime limits on total costs, include various preventive care with no co-payment, and let unmarried dependent children stay on their parents’ policies until the age of 26. Additional requirements will take effect in 2014.”