Commentary Magazine


Topic: state insurance exchanges

Court Ensures ObamaCare Debate Is Just Getting Started

Even amid a spate of bad news about their Senate candidate’s chances in November, Democrats have been celebrating the way ObamaCare seems to have fallen off the country’s political radar recently. Though the president’s signature health-care law is still deeply unpopular, the issue has been largely eclipsed by general concerns about presidential leadership and scandals in the midterms. But the confidence on the part of the administration and its supporters that this issue was finally settled had to be shaken by a federal court decision yesterday that essentially eviscerated the ability of the law to function in most of the country. If it holds up on appeal, the ruling will not only largely undo the president’s legislative triumph but also set the stage for a new spirited debate on health care that Democrats were hoping to avoid.

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Even amid a spate of bad news about their Senate candidate’s chances in November, Democrats have been celebrating the way ObamaCare seems to have fallen off the country’s political radar recently. Though the president’s signature health-care law is still deeply unpopular, the issue has been largely eclipsed by general concerns about presidential leadership and scandals in the midterms. But the confidence on the part of the administration and its supporters that this issue was finally settled had to be shaken by a federal court decision yesterday that essentially eviscerated the ability of the law to function in most of the country. If it holds up on appeal, the ruling will not only largely undo the president’s legislative triumph but also set the stage for a new spirited debate on health care that Democrats were hoping to avoid.

A federal judge in Oklahoma ruled yesterday in Oklahoma v. Burwell that the government could not extend subsidies to ObamaCare customers in the 36 states where no state exchange currently exists. Judge Ronald A. White rightly decided that the president’s policy of giving the subsidies in all states flatly contradicted the wording of the Affordable Care Act which states that the tax credits could only apply to insurance purchased “through an exchange established by the state.” The administration had claimed it was “standing in the shoes” of the states that refused to set up their own insurance marketplaces, but this was correctly dismissed as an abuse of power with no basis in law.

Who’s to blame here? Democrats will blame Republican judges, but they should be castigating themselves. This is, after all, the bill that then House Speaker Nancy Pelosi famously said had to be passed before it could be understood. But in their rush to force it down the throats of the country in 2010, they made a fatal drafting error.

While the attorney general of Oklahoma, which challenged the Department of Health and Human Services in this case, praised the decision as “a victory for the rule of law,” there is more at stake here than the question of whether the administration can change an existing law by presidential fiat. This is no technicality. If upheld (other federal courts have split on the question), the ruling will cut off federal subsidies for more than 4.5 million of those who have enrolled in ObamaCare essentially gutting the effectiveness of the law. It cannot function without the subsidies. Since complying with the ruling would require Congress to amend the ACA to cope with the fact that a majority of states wouldn’t set up exchanges, this could end its implementation for the foreseeable future.

This means ObamaCare is heading back to the U.S. Supreme Court where Chief Justice John Roberts’ illogical decision allowed it to survive a challenge to its constitutionality. Would Roberts somehow step in again to save ObamaCare? There’s no telling which way he would jump. But no matter what he does, the president’s supporters can’t feel comfortable once again placing the future of the law in Roberts’ hands.

Just as important, this will also mean that the debate over ObamaCare will be heating up again in 2015. The expected skyrocketing of insurance rates caused by the law as well as what may be a disastrous impact on the economy when the employer mandate is put into effect already made Democratic predictions of its acceptance look foolish. But with the fate of the entire project now up in the air, the debate (which Democrats predicted would already be over) about the merits of this still unpopular law will be heating up next year.

Far from being consigned to the dustbin of history as the president and his fans have often claimed, the ObamaCare debate not only isn’t dead, but the flawed nature of the legislation has ensured it will be bedeviling Democrats in 2015 as much if not more than before.

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Oh the Irony; Liberal NYC Elites are ObamaCare Losers

In the last few weeks the country has gradually become acquainted with the large and growing class of Americans that fall into the category of ObamaCare losers. The president and his cheerleaders in the liberal media have tried to change the subject from the dysfunctional website and the broken promises about keeping your coverage to one about the poor and those with pre-existing conditions who will now get health insurance. But it’s been hard to ignore the equally numerous people who have lost their coverage and been forced to accept more expensive plans that don’t suit their personal needs and come with enormous deductibles and other hidden costs. Most of these people are small business owners, contractors, and skilled craftsman in Middle America that aren’t likely to hobnob with the chattering classes. But it turns out that some of the biggest ObamaCare losers in the country are liberal elites living in the media capital of the world. And, though they thought the whole concept of bringing government into the health-care business was great, they are none too pleased about personally being victimized by the president’s big idea.

As the New York Times reported over the weekend, some prominent New York City liberals have recently found out just how unaffordable the so-called Affordable Care Act turned out to be. As many as 400,000 New Yorkers who are lawyers, doctors, writers, photographers, independent teachers, and even opera singers, who have been getting their health insurance via creative guilds and other entities that allowed these people to buy coverage in groups, have now been thrown into the individual market by ObamaCare.

They are part of an unusual, informal health insurance system that has developed in New York, in which independent practitioners were able to get lower insurance rates through group plans, typically set up by their professional associations or chambers of commerce. That allowed them to avoid the sky-high rates in New York’s individual insurance market, historically among the most expensive in the country.

But under the Affordable Care Act, they will be treated as individuals, responsible for their own insurance policies. For many of them, that is likely to mean they will no longer have access to a wide network of doctors and a range of plans tailored to their needs. And many of them are finding that if they want to keep their premiums from rising, they will have to accept higher deductible and co-pay costs or inferior coverage.

The result is that a large number of liberals are getting a good look at the business end of ObamaCare and don’t like the view.

Read More

In the last few weeks the country has gradually become acquainted with the large and growing class of Americans that fall into the category of ObamaCare losers. The president and his cheerleaders in the liberal media have tried to change the subject from the dysfunctional website and the broken promises about keeping your coverage to one about the poor and those with pre-existing conditions who will now get health insurance. But it’s been hard to ignore the equally numerous people who have lost their coverage and been forced to accept more expensive plans that don’t suit their personal needs and come with enormous deductibles and other hidden costs. Most of these people are small business owners, contractors, and skilled craftsman in Middle America that aren’t likely to hobnob with the chattering classes. But it turns out that some of the biggest ObamaCare losers in the country are liberal elites living in the media capital of the world. And, though they thought the whole concept of bringing government into the health-care business was great, they are none too pleased about personally being victimized by the president’s big idea.

As the New York Times reported over the weekend, some prominent New York City liberals have recently found out just how unaffordable the so-called Affordable Care Act turned out to be. As many as 400,000 New Yorkers who are lawyers, doctors, writers, photographers, independent teachers, and even opera singers, who have been getting their health insurance via creative guilds and other entities that allowed these people to buy coverage in groups, have now been thrown into the individual market by ObamaCare.

They are part of an unusual, informal health insurance system that has developed in New York, in which independent practitioners were able to get lower insurance rates through group plans, typically set up by their professional associations or chambers of commerce. That allowed them to avoid the sky-high rates in New York’s individual insurance market, historically among the most expensive in the country.

But under the Affordable Care Act, they will be treated as individuals, responsible for their own insurance policies. For many of them, that is likely to mean they will no longer have access to a wide network of doctors and a range of plans tailored to their needs. And many of them are finding that if they want to keep their premiums from rising, they will have to accept higher deductible and co-pay costs or inferior coverage.

The result is that a large number of liberals are getting a good look at the business end of ObamaCare and don’t like the view.

“I couldn’t sleep because of it,” said Barbara Meinwald, a solo practitioner lawyer in Manhattan.

Ms. Meinwald, 61, has been paying $10,000 a year for her insurance through the New York City Bar. A broker told her that a new temporary plan with fewer doctors would cost $5,000 more, after factoring in the cost of her medications.

Ms. Meinwald also looked on the state’s health insurance exchange. But she said she found that those plans did not have a good choice of doctors, and that it was hard to even find out who the doctors were, and which hospitals were covered. “It’s like you’re blindfolded and you’re told that you have to buy something,” she said.

This is exactly what conservative critics of ObamaCare have been saying. Though the president and his liberal defenders have been claiming the individual plans canceled by ObamaCare provided bad coverage, these New York elites beg to differ. They liked their plans and, more to the point, they liked being able to band together in creative and business association guilds so as to pool their resources and get more affordable coverage.

But that ran afoul of the redistributionist social engineering of the ACA that views these professionals not as citizens entitled to the best care at affordable prices but as healthy fodder whose sole purpose is to be gouged by the government system in order to pay for free care for less healthy and poorer people. Being shuffled into the state exchanges means these New Yorkers not only get lousier coverage but also are facing exorbitant rate increases.

To say that these generally liberal New Yorkers don’t care for the experience is an understatement.

It is not lost on many of the professionals that they are exactly the sort of people — liberal, concerned with social justice — who supported the Obama health plan in the first place. Ms. Meinwald, the lawyer, said she was a lifelong Democrat who still supported better health care for all, but had she known what was in store for her, she would have voted for Mitt Romney.

It is an uncomfortable position for many members of the creative classes to be in.

“We are the Obama people,” said Camille Sweeney, a New York writer and member of the Authors Guild. Her insurance is being canceled, and she is dismayed that neither her pediatrician nor her general practitioner appears to be on the exchange plans. What to do has become a hot topic on Facebook and at dinner parties frequented by her fellow writers and artists.

“I’m for it,” she said. “But what is the reality of it?”

Conservatives may be forgiven a few chortles at their expense. But their plight is no less a source of concern than that of millions of other Americans who have similarly been given the shaft by the president’s signature health-care legislation. The political problem faced by liberals who have assumed that once ObamaCare was implemented it would become popular is that unlike Social Security and Medicare, the number of Americans who are net losers under the bill’s provisions may wind up being as numerous as those who benefit from it. That some of them are “Obama people” is ironic, but it also highlights the fact that those who are being hurt by ObamaCare are a group that cuts across geographic, class, and political lines.

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Bad Policy, Worse Politics

James Capretta and Yuval Levin make a key point about the health-care bill snaking its way through Congress:

This timeline of tax and spending implementation corresponds rather awkwardly to the political calendar confronting the Democrats. The new entitlement, insurance rules, and other elements of the plan will not go into effect until well after the 2010 congressional elections and even the next presidential election, but some serious tax hikes will take place by then.

Meanwhile, again to make for a palatable CBO score, the bill envisions radical cuts in Medicare beginning quite soon. For instance, steep cuts in Medicare Advantage start in 2011, which means millions of seniors will begin hearing the bad news in 2010 as their plans withdraw from the program, cut their benefits, or raise their premiums.

So how exactly does this play out in the 2010 elections? Republicans will be holding up the Medicare cuts and urging seniors to run to the polls and vote the Democrats out. The Democrats will either savage their own bill by undoing the cuts or defend it as is, while explaining that other voters should be happy because by 2014 they will get subsidized health care. (“Essentially all of the spending provisions and insurance reforms–including the individual mandate to purchase health insurance, the employer mandate to provide it, the state insurance exchanges, the federal subsidies for coverage, and the Medicaid expansion–would only go into operation in 2014.”) Gosh, who has the better argument?

Then let’s break that down on a race-by-race level. In states where voters overwhelmingly oppose ObamaCare, Republicans running against incumbents like Byron Dorgan, Blanche Lincoln, and Harry Reid will run against the taxes, mandates, fees, and corruption. Republicans running in Blue states like California will question why someone like Barbara Boxer didn’t do a “better job” and allowed Nebraska or Iowa to get Medicare carve-outs, leaving their seniors to scrounge for doctors (who won’t make ends meet on Medicare’s reduced fees) and to live without their much-loved Medicare Advantage benefits. What exactly are the Democrats going to say to voters in an off-year election who are generally older, more conservative, and more politically savvy than the masses who turn out for a presidential election? I’m sure aggrieved voters will be delighted to hear that the bill is “historic.” But that means nothing to most of them, who have insurance and whose benefits and taxes are going to be impacted in a huge government power grab.

So if the bill makes no sense on the merits, it makes even less sense politically. The only question remains whether nervous incumbents figure this out and grudgingly agree to return to the drawing board. If not, they better figure out how they are going to defend this in front of enraged voters.

James Capretta and Yuval Levin make a key point about the health-care bill snaking its way through Congress:

This timeline of tax and spending implementation corresponds rather awkwardly to the political calendar confronting the Democrats. The new entitlement, insurance rules, and other elements of the plan will not go into effect until well after the 2010 congressional elections and even the next presidential election, but some serious tax hikes will take place by then.

Meanwhile, again to make for a palatable CBO score, the bill envisions radical cuts in Medicare beginning quite soon. For instance, steep cuts in Medicare Advantage start in 2011, which means millions of seniors will begin hearing the bad news in 2010 as their plans withdraw from the program, cut their benefits, or raise their premiums.

So how exactly does this play out in the 2010 elections? Republicans will be holding up the Medicare cuts and urging seniors to run to the polls and vote the Democrats out. The Democrats will either savage their own bill by undoing the cuts or defend it as is, while explaining that other voters should be happy because by 2014 they will get subsidized health care. (“Essentially all of the spending provisions and insurance reforms–including the individual mandate to purchase health insurance, the employer mandate to provide it, the state insurance exchanges, the federal subsidies for coverage, and the Medicaid expansion–would only go into operation in 2014.”) Gosh, who has the better argument?

Then let’s break that down on a race-by-race level. In states where voters overwhelmingly oppose ObamaCare, Republicans running against incumbents like Byron Dorgan, Blanche Lincoln, and Harry Reid will run against the taxes, mandates, fees, and corruption. Republicans running in Blue states like California will question why someone like Barbara Boxer didn’t do a “better job” and allowed Nebraska or Iowa to get Medicare carve-outs, leaving their seniors to scrounge for doctors (who won’t make ends meet on Medicare’s reduced fees) and to live without their much-loved Medicare Advantage benefits. What exactly are the Democrats going to say to voters in an off-year election who are generally older, more conservative, and more politically savvy than the masses who turn out for a presidential election? I’m sure aggrieved voters will be delighted to hear that the bill is “historic.” But that means nothing to most of them, who have insurance and whose benefits and taxes are going to be impacted in a huge government power grab.

So if the bill makes no sense on the merits, it makes even less sense politically. The only question remains whether nervous incumbents figure this out and grudgingly agree to return to the drawing board. If not, they better figure out how they are going to defend this in front of enraged voters.

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