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.
“Back when Secretary Sebelius was nominated for her current position, a colleague enthused that, ‘An insurance commissioner is a great choice for Secretary of HHS, because his or her direct contact with consumers provides unique insight into the challenges…..’ Unfortunately, Secretary Sebelius’ current direct contact with the Beltway political class and its ideological agenda obviously have far more significance than her previous direct contact with consumers, whose suffering under ObamaCare has only just begun.”
New insurance exchanges are supposed to make insurance companies more responsive to market forces, but will instead give government control over the market. “In theory, they will expose health insurance customers to greater competition while protecting them through regulation. Insurers participating in the exchanges, for example, will face strict limits on how they can price their premiums according to individual risk factors. In practice, they will likely prove difficult to design and implement, and may ultimately undermine the country’s quality of care. No matter what, there is little doubt that the exchanges will fundamentally alter the health insurance landscape across the states.”
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.”
“McDonald’s Corp. has warned federal regulators that it could drop its health insurance plan for nearly 30,000 hourly restaurant workers unless regulators waive a new requirement of the U.S. health overhaul. The move is one of the clearest indications that new rules may disrupt workers’ health plans as the law ripples through the real world.”
“The provisions that are going into effect this year aren’t central to the law’s significant changes to American health care. Repeal is resonating with a large segment of the population because much more sweeping changes are in the works, changes that will redistribute wealth, disrupt insurance arrangements that most people find perfectly acceptable today, and create risks for the quality of American health care. Those concerns are not going away anytime soon.”
“The Obama administration has a dilemma. On the one hand, it wants to be seen as the champion of preventive care — because these are the only tangible services that touch the lives of the 80 percent of the population that is basically healthy. On the other hand, a vast increase in insurance coverage for such services will only increase health care costs and crowd out access to care for those who have more serious medical needs.”
Businesses are unable to plan for ObamaCare’s new mandates and taxes, because of the regulatory complexity. “But at this point, the answer is just not knowable, since regulators still have to write so many regulations, including what health services employers will be required to cover under mandatory insurance.”
“It’s now been six months since Congress passed Obamacare — not a long time given the sweeping nature of the legislation and the long phase-in schedule for its most significant provisions. Even so, it is already abundantly clear that Obamacare’s critics were dead right: The new health law has set in motion a government takeover of American health care, and a very hostile one at that. The Obama administration’s clumsy and overbearing behavior since its passage proves the point.”
“ObamaCare’s a painful shot in the wallet. A Greenwich Village resident was socked with an eye-popping 25 percent increase in health premiums — and his insurance company is slapping part of the blame on President Obama’s health-care overhaul that took effect yesterday… Doug Gowland’s monthly bill will jump $140 — from $565 to $705 — under the hike, according to a letter he received from insurer EmblemHealth. In the notice, EmblemHealth told Gowland, who is healthy, ‘The proposed rate increase includes two components: a basic increase on your type plan and an increase due to the cost of enhanced benefits required by the new federal Patient Protection and Affordable Care Act.'”