The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

Longtime opponents of the ObamaCare “Cadillac tax” met with lawmakers this week with a new message: We’re willing to compromise. In a fly-in visit with key members and committee staff, employer benefits lobbyists went in seeking a more politically viable solution than full repeal. Rather than eliminating the tax entirely, they pitched exempting the contributions that are made to employers’ health savings accounts, which could otherwise be subject to the 40 percent excise tax.

Obamacare’s third year of open enrollment began on Sunday. People hoping to sign up saw a website with fresh photos and high-tech features. They found the actual insurance of the president’s signature law has gotten even worse. Unless something dramatic happens, this may be the year of the health care law’s collapse. Prices keep rising and service keeps fading. It should not surprise the administration that people are not signing up.

The Affordable Care Act’s third open enrollment season got under way, with a new array of health plans that show how the law’s influence is starting to transform the insurance industry. Sunday’s kickoff appeared to go relatively smoothly, with little evidence of technical glitches at as consumers started to shop for coverage that will take effect in 2016.

Health and Human Services Secretary Sylvia Burwell announced recently that she expects 10 million people to be enrolled in health-care coverage through ObamaCare’s exchanges by the end of next year. What she didn’t mention was that in March of last year the Congressional Budget Office predicted that 21 million people would be enrolled in 2016—more than double the new estimate.

The Obama administration on Sunday begins what is expected to be the toughest enrollment period yet for ObamaCare. The administration has sought to lower expectations, trimming back its overall enrollment projection while warning that the people who remain uninsured will be the hardest to reach.

Shopping for health insurance on starting Sunday will find fewer plans offered by about the same number of insurers, the Obama administration announced Friday. A snapshot of the plans being sold on the Obamacare online marketplaces this year shows that the average consumer will have 50 plans to choose from in their county, down from an average of 58 plans last year.

The Pacific Legal Foundation filed an appeal Monday asking the Supreme Court to hear a new challenge to the Affordable Care Act which argues that the ACA’s taxes are unconstitutional because they originated in a bill written by the Senate.

Under the Constitution’s Origination Clause, all bills that levy and raise taxes must begin in the House of Representatives. Contrary to this provision, the text of the ACA was written by the Senate and later adopted by the House. Senate Majority Leader Harry Reid gutted an unrelated House bill, leaving only the bill number, and in its place, he inserted the 2,076 pages of the ACA.

The PLF contends that the ACA’s taxes were therefore unconstitutionally created in a bill written by the Senate.

In 2012, the Supreme Court decided in NFIB v. Sebelius that the individual mandate, a requirement in the ACA forcing Americans to purchase health insurance or else pay a penalty, is indeed a tax. The Supreme Court did not however address the implications of the Origination Clause on this conclusion.

PLF’s lawsuit, Sissel v. U.S. Department of Health & Human Services, specifically targets the individual mandate to prove that all of the ACA’s taxes are unconstitutional under the Origination Clause.

“Beyond its assault on healthcare freedom, Obamacare represents an attack on some core constitutional principles and protections for taxpayers,” according to PLF’s Principal Attorney Timothy Sandefur.  “Obamacare raises taxes by hundreds of billions of dollars, but it was enacted in violation of the Origination Clause, which was designed to safeguard against arbitrary and reckless taxation.”

Four of the nine justices must vote to hear the case before it is placed on the court’s docket.

View PLF’s petition for writ of certiorari here.

Our health care system is a complex system. As I explained in Priceless, there is no known, reliable model of how it works. Whatever policy changes we make, there are certain to be unintended consequences and they may make matters worse than when we started. So how should we approach health policy? In an article in the Journal of Legal Medicine, I argued that before we try to solve social problems in health care we should first make sure that government is not the cause of the very problems we are trying to solve. How do we do that? By identifying the major ways in which government policies create harmful, perverse incentives and then replacing them with neutral (do no harm) policies. Once we have removed the perverse incentives government has created, we will be in a position to see if there are any remaining problems that need to be solved. is going to see some shrinkage in 2016. The number of health insurance plans available on that huge federal Obamacare marketplace for 2016 is decreasing by up to 12 percent compared with this year, industry sources told CNBC. And there will be an even sharper reduction — of more than 40 percent — in the number of health plans on known as PPO plans, which offer customers the most flexibility in where they can get medical services covered by their insurer, sources said.

After months of internal debate, the House passed a budget-reconciliation bill last Friday taking aim at Obamacare, but it is far from assured that the bill, or even an amended version of it, will ever emerge from the Senate. Budget-reconciliation bills are powerful legislative vehicles because they cannot be filibustered in the Senate (it takes 60 votes to invoke cloture and close off debate on most bills). That means, in theory at least, that the Republican majority in the Senate should be able to pass a reconciliation bill and send it to the president for signature or veto without needing any Democratic support.