If you spend any time on Twitter or Facebook, you’ve undoubtedly come across the “#Defund” hashtag. If you follow the news even cursorily (and odds are you follow it more closely than that, if you’re reading this) then you also know the House of Representatives voted yesterday to continue funding government operations until December. Everything, that is, except the Affordable Care Act – more popularly known as “Obamacare.”
The President’s reaction? He’s taking the CR personally, certain that the motivation behind it cannot be ideological in nature. “They’re not focused on you. They’re focused on politics. They’re focused on trying to mess with me. They’re not focused on you” he stated during yet another campaign speech yesterday. (As an aside, why is he campaigning? I thought the election was last November.) While my personal dislike for the the man in the Oval Office has grown considerably over the last five years, my disdain for Obamacare hearkens all the way back to its inception. Trust me on this one, Mr. President. My opposition is nothing personal – and neither is it for the people with whom I’ve conversed with on the subject.
I support the defund movement, because it is our last, best hope of getting rid of the “train wreck” (Max Baucus, the guy who helped write the ACA, called it that) and replacing it with something that actually addresses the rising costs and failed delivery of health care in the United States. I support the defund movement, because the economic impact of even a temporary federal shutdown would be far less than realized from your weapon of Mass Economic Destruction. Finally, I support the defund movement because the American people have had about all they can take of Obamacare.
Let’s start with that last point first. That you’ve always a had somewhat regal view of the Presidency is certain. Since early on, you’ve complained that you aren’t a dictator, or king, or emperor, or president of China. The actual concerns of the average American were hardly the thing that kept you awake at night; why else the dozens of “pivots to the economy” over your 5+ years in office? Over the past year, overwhelming evidence was exhumed that you consider yourself above the American people. From the failure in Benghazi, to the IRS crackdown on conservative and libertarian groups, through the revelation that the NSA is spying on everyone, to your recent attempt to force the nation into an ill-conceived war in Syria, said evidence is damning. You really did think for a while there that you are a de facto dictator.
Obamacare was our precursor. Yes, the American people wanted something done about health care. But what we wanted and what we eventually got are two very different things. Instead of reform that lowered costs and made delivery easier, we simply got told we had to go buy health insurance – or else. No matter, we were assured countless times since: once the law rolls out, you’ll love it! Why, didn’t Nancy Pelosi tell us that in order to find out all about the wonderful goodies in the ACA, Congress had to pass it first? The sycophant press quickly dubbed the new law “Obamacare” and you ‘begrudgingly’ accepted the name. FDR had the New Deal, LBJ had the Great Society, BHO had Obamacare.
Never mind that your signature piece of legislation has never been popular with the very people it is supposed to help. Polls show what support existed at passage has slowly slipped away. It’s your signature piece of legislation, by golly! So of course you’re right to be mad at Congress for attempting to undo the damage done, for seeing it as a personal attack and a personal affront. Never mind that the CR defunding Obamacare is actually more popular than the law and never mind that it enjoys popular support (and not just among the Tea Party). Never mind that it’s very passage is regarded is the single most important reason your party lost control of Congress in the 2010 mid-terms. If you refuse to sign that CR, then it’s the Republicans’ fault that the government runs out of operating cash on October 1. Not your own pigheadedness, not your own wanting to be a dictator – or failing that, being seen as the most “transformational” President since FDR.
About that threatened federal shutdown. We’ve been down that path a few times and quite frankly, they aren’t that scary to most Americans. There will be an inconveniences, of course. For instance, I won’t be able to track a flight on the NTSB’s website. I won’t be able to call the IRS with a question about my taxes (which, by the way, I’d probably sit on hold for 20 minutes and then be told to ask my tax professional). But we already know from past experience that essential government functions will continue: the Army won’t be disbanded, the FBI will keep hunting bank robbers, grandma will still get her social security check. Even progressive economists admit the actual economic impact would be minimal, resulting in a reduction of less than 1% of GDP.
But the economic impact of Obamacare is already being felt across the economy. Nobody has a full accounting thus far, but in the past week alone nearly 500,000 people have had their hours cut to 28 or fewer and their existing health coverage terminated. Another 35,000 have lost their jobs completely. Although you love to tout the million jobs created in 2013, you have yet to acknowledge the fact that 1.2 million of those jobs are part-time, without health coverage. Those are real economic impacts directly attributable to your signature legislation. Here’s another impact you may not want to acknowledge: those workers are not only facing a drop in income from reduced pay, they are now going to be hit with a new expense: mandated health coverage. Sure, there’s a subsidy headed their way (provided Obamacare is fully funded) – but those subsidies won’t cover the full cost for health insurance. A government shutdown might reduce GDP by 1%. But Obamacare is easily dropping GDP farther than that and will cause it to crash even further. All this was avoidable, but neither you nor your progressive friends apparently live in the real world, the one in which businesses aren’t going to spend a dime more than necessary. You were warned by everyone from the Chamber of Commerce to (gulp) Donald Trump, but still you refused to listen. The economic mess your signature legislation created is wholly owned by you, as well as the Senators and Congressmen you bought off.
Finally, there is the train wreck. I could list everything that has gone wrong so far with getting this mess in place, but I did that a while back. To that list I add three more fiascos: the doctor shortage, the uninsured and one I’ll keep you guessing about until the end.
The doctor shortage was known and supposedly addressed in the ACA. Simply put, there aren’t enough primary care doctors available to cover everyone. Getting an appointment to see your doctor is already hard enough (and let’s not forget the wait times once you’re in the waiting room). The AMA now anticipates that wait times are going up by about 6% – and nobody anticipates getting an appointment will get easier. Will we see British-type difficulties in getting an appointment, with waits as long as a month? Will they be more like typical waits in the VA system, where it can take up to 6 months to get an appointment? Nobody knows, but the alarm bells should be sounding: in the New York metro area, a recent study found that time to appointment was now ranging from 6 to 61 days, with an average of 24.
The uninsured? When Obamacare was trotted out to the public, we were told that all but a few, perhaps 3 million, of those without insurance wouldn’t be covered. In March, CBO blew that apart with a new estimate: 7.5 million. Last week, that get shattered again, when DHS announced that because of the rollbacks, waivers and deferments, that as many as 30 million people still would be uninsured come January 1, 2015. That would mean we went through all these gyrations over the last 36 months to insure an additional 2 million. Call me what you will, but that amounts to the second biggest load of crap ever handed the American people from Washington DC.
The biggest load of crap ever? Well, here’s the caboose of the Obamacare train wreck. Mr. President, you have promised us that “If you like your health plan, you can keep it.” You’ve pummeled the American people with that line for over four years, even though as far back as June, 2009 you admitted yourself that the statement WAS A LIE. Now millions of Americans are finding out what a monstrous pile of horse manure that line really is. Insurance companies, because of the regulatory morass that this demon child legislation created, are gutting health plans and informing their customers that come January 1, 2014 their current insurance will no longer be available.
In short, I’m supporting the #DEFUND movement because really, what other choice does our country have?
Some of you may recognize the title of this post as part of a quote from Winston Churchill:
“Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”
Although Sir Winston was talking about the Battle of Egypt, the same could be said of Obamacare today. Since this is a holiday week, there is a good chance that you missed the announcement from the Treasury department on Tuesday afternoon. The Obama administration unilaterally decided to delay implementation of the employer mandate part of the law until 2015. Never mind that this is another example of a President who repeatedly decides which laws he’ll enforce (in direct contravention to the Constitution). That’s a another post for another day. No, this is yet another example of what was supposed to be the greatest thing since sliced bread is actually what a whole bunch of us realized it was from the beginning: in military parlance, a BOHICA SNAFU. (For those of you unfamiliar with military terms, this is a family blog. Feel free to use a certain search engine to look it up).
How bad has this been? There are bad laws and there are poorly executed laws. But this law was less about the stated intention (revamping the American healthcare system to provide easier access, with lower costs, for all Americans) than it was about a political power play between the two major parties. The result was a poorly conceived law, rammed through an indifferent Congress by a power-hungry administration, crammed full of pork and incapable of actually working. Every day seems to bear out the fact that nobody read the ACA before the final vote (even if they had, it would have taken a year more just to figure out the details).
To date, there have been 10 instances where the Obama administration has been forced to admit defeat on a particular program in the ACA. The reversal on the employer mandate is the latest, and one of the most critical. The reason they gave, that businesses needed more time to figure out the paperwork, is as believable as the tooth fairy. The real reason is that businesses already figured out how to avoid the paperwork completely: keep workers under the 30 hour limit which would trigger the mandate. Friday’s jobs report, which showed that more part-time jobs were created than full-time jobs, underscored this.
Score one for those of us who warned that Obamacare was an economy killer.
Unfortunately for the American worker, the individual mandate is still in place. The removal of the employer mandate means that some 36% of Americans are now going to be forced into purchasing private medical insurance. The employer mandate proved politically unworkable in practice, I suspect that by October (when everyone needs to start shopping) the individual mandate will prove even more politically impractical.
By the way, here are the 9 previous ACA failures:
- The CLASS Act: a long-term care insurance program that died last year. The reason? The law, as written, couldn’t be funded. The supposed budget savings amounted to 40% of the total deficit reduction attributed to the ACA.
- Federally mandated insurance exchanges: States were given literally unlimited funds to set up insurance exchanges that would allow uninsured folks to shop for coverage. The problem is that only 17 states have bothered with setting up the exchanges and the law requires HHS to set up exchanges for any state that doesn’t. But the ACA failed to foresee that states might not want to bother with the regulatory and administrative nightmares in trying to create a health care exchange and provided zero funds. HHS estimates it will cost at least $1.5 billion dollars to get the exchanges up and running. Good luck with that.
- Small business exchanges: along the lines of the individual exchanges, these were intended to allow small business employees to access the same rates enjoyed by employees at major corporations. They aren’t dead yet – but like the employer mandate, they have been delayed until 2015. The problem isn’t political here, though – it’s a real-world issue. Namely, how do you get the same actuarial certainty for an employee at a company with 10 employees as one who works with 1,000 other people? (Trick question: you can’t do it. But remember, the math geniuses in Congress who dreamed this up also raise government spending, then call it a “budget cut.”)
- 1099 reporting: This was a major funding tool for the ACA that was scuttled because it amounted to both a new tax and a reporting headache for every employer in the country.
- The Great Waiver Debacle: a provision in the ACA allowed HHS to issue waivers to organizations that could prove they needed them. Lo and behold, the Political Patronage and Payback Machine kicked into high gear. Over 1200 waivers have been granted (nobody knows for sure, because HHS stopped reporting the numbers a few months back). But if you gave to the Obama campaign or the DSCC, it looks as if you got a waiver. Funny how a law that was supposed to benefit everyone has proven so incredibly unpopular in core Democratic Party constituencies.
- The Pre-Existing Plans: great idea, on paper. Anyone who has a preexisting condition knows how difficult it is to find medical insurance. But once again those Congressional mathematicians didn’t realize how much it would cost to insure everyone – and the program has already run out of money. No more people are being accepted, even though HHS estimates that only 30% of those eligible are covered.
- Children Only Plans: under the ACA, if an insurance company sells child-only healthcare plans they need to offer coverage to kids with preexisting conditions. Somebody forgot to tell Congressional Dems the way the marketplace works (that companies do not willingly increase costs without some future benefit). The child only plans have virtually disappeared from the marketplace, a casualty of Obamacare.
- The “Basic Health Care Plan”: What’s that you say? You’re in perfect health, you’re young and you really don’t want to pay for full coverage that you can’t afford, even with the promised subsidies? Well, not to worry: the ACA mandated that states offer a basic plan – or essentially, catastrophic coverage-only. Except, as with the other mandates, it has proven unworkable and pushed back to 2015.
- “If you like it, you can keep it”: I saved the best for last! The greatest example of marketing hucksterism exhibited by the Obama administration was the President’s repeated assurances that if you liked you current health coverage, you would get to keep it after the ACA was passed. It’s pretty clear at this point that either the President is as dumb as rock when it comes to market economics or a bald-faced liar, because millions of Americans no longer have the health insurance options they had 4 years ago. Heck, HHS expects that some 126 million Americans will see a “significant” change to their health coverage as a result of the ACA.
The administration and Congressional Dems keep telling us that we’ll love Obamacare once it fully takes effect. They insist the law’s problems have more to do with poor marketing and Republican obstructionism than any basic flaws. But the record on implementation has more failures than successes and the law keeps proving to be more and more unpopular across all demographics.
Here’s a suggestion for the President. Admit that the latest reversal is, in fact, proof that the ACA is a disaster. Politically, it swept your party out of power in 2010 and is threatening to reinforce those losses in 2014. If you are truly interested in your legacy, which seems to be the general consensus among the DC elite, then do something no President has done.
Declare that your “signature accomplishment” is failing to deliver on the promises it made. Ask Congress to repeal it, scrap it and consign it to the dust heap of history. Ask Congress to work together to craft a healthcare reform package that actually works to improve delivery and reduce costs. In short, take ownership and command the respect true leadership creates.
This is the beginning of the end. The only question at this point is whether the President can rewrite the script and create a happy ending. If the past 5 years are any indication, he is politically incapable and (more importantly) personally unable to do so – and the nation will suffer as a result.
I’ve read today – far too often today – that Chief Justice of the United States Supreme Court John Roberts is a cross between Judas Iscariot, Pontius Pilate and Benedict Arnold. Or maybe something worse. Although I doubt Chief Justice Roberts needs me to come to his defense (or that he even cares, to be honest), I’m going to give it a shot. Let’s look into what the Supreme Court ruling on the PPACA actually means before passing judgement, shall we?
The Supreme Court ruled that the government cannot compel anyone to buy anything. Ever.
Big? You bet this is huge. We’ve heard for two years from academicians and progressives that under the Commerce Clause, Congress has the ability to force us to buy stuff. Their theory was that because everyone needs health care at some point, we all engage in commerce related to the health industry and the very act of not purchasing health insurance was an action. Well, not so fast.
“The individual mandate, however, does not regulate existing commercial activity. It instead compels individuals to become active in commerce by purchasing a product, on the ground that their failure to do so affects interstate commerce. Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority…The Framers gave Congress the power to regulate commerce, not to compel it, and for over 200 years both our decisions and Congress’s actions have reflected this understanding. There is no reason to depart from that understanding now.”
So, the Obama administration’s argument (echoed by the same academicians above) got the royal smack-down. Chief Justice Roberts may as well have wrote, “What are you, a bunch of moe-rons?”. The result is the same. Rarely does a published opinion go this far (nearly 16 pages) to explain why an argument is so plainly stupid.
The Supreme Court ruled that ObamaCare is the biggest tax hike in US history.
Yes, they ruled the PPACA can move forward, but that the government can no longer try and hide behind the facade of an individual mandate. No, they ruled: ObamaCare is actually a tax increase. Or more precisely, a combination of 21 different tax increases that total $1.2 trillion in new revenue annually. How big is that? It amounts to new taxes that consume 8% of the nation’s economic output. With only a little over 4 months until the election, I’m not sure how either the President or his minions in Congress feel about running for election on a platform of delivering the biggest tax increase in history. I doubt they’re relishing the chance to find out. Already the cries are being raised about the impending sequestration, with it’s 1.5% tax increase and strong possibility of pulling the economy back into recession. ObamaCare represents a tax increase more than 5 times that impact. By ruling as they did, the Court hand-delivered a gift-wrapped campaign theme for the Republicans this Fall. “If you thought the economy was bad before, just wait until ObamaCare sinks it forever.”
States cannot be forced to participate in ObamaCare.
A big part of how ObamaCare delivers affordable insurance to the masses is through a massive expansion in Medicaid, by enrolling anyone at 133% of the federal poverty line or below in the program. A big part of how the administration covers up the cost of that expansion is by removing federal subsidies for it by 2017, but still compelling the states to pick up the tab. As of right now, 13 states are balking at the idea of pushing their budgets into the red to make good on this mandate. The Supremes issued another smack-down on this, ruling that unfunded mandates are unconstitutional, even if the mandate is to an existing program.
“It is enough for today that wherever that line may be, this statute is surely beyond it. Congress may not simply “conscript state [agencies] into the national bureaucratic army,” and that is what it is attempting to do with the Medicaid expansion.”
Either the administration can relent and pick up the entire tab for the Medicaid expansion, or live with fact that the original goal of covering more than 95% of Americans in some form of health plan is by the boards.
So, is this really a win for Team Obama? Only in Pyrrhic sense. Yes, the PPACA stands for now – but not all of it. The Medicaid smack-down means that a very large part of the administration’s base of support won’t see any benefit from the law. As for the rest of it, Team Obama is now left to campaign on the largest tax hike in history, in the middle of the worst economy in 80 years. It is also already galvanizing support for the Republican challenger as nothing else could have – especially given Mr. Romney’s own dubious record on health reform.
The President may be heading to bed this evening with a smile on his face. But I bet the one on the Chief Justice’s face come November 6th will be a bit bigger.
The Supreme Court issued their ruling on the Patient Protection and Affordability Care Act earlier this morning. The short story is, the act stands. But there is much in the ruling that I can see making the President and entire Federal government wishing they had never taken this up to begin with.
For staters, the Individual Mandate is completely unconstitutional. No ifs, ands, or buts.
“Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority. Congress already possesses expansive power to regulate what people do. Upholding the Affordable Care Act under the Commerce Clause would give Congress the same license to regulate what people do not do. The Framers knew the difference between doing something and doing nothing. They gave Congress the power to regulate commerce, not to compel it. Ignoring that distinction would undermine the principle that the Federal Government is a government of limited and enumerated powers. The individual mandate thus cannot be sustained under Congress’s power to “regulate Commerce.'”
Instead, the Court ruled that Congress can impose a “health tax” as part of the individual tax code, but again, it cannot apply a penalty to persons who refuse to participate in the insurance market. They can only impose the tax uniformly – on everyone – and then refund or credit people who do buy insurance.
But the biggest bombshell coming from this ruling is the Court’s take on unfunded federal mandates. They’ve basically eviscerated one of Washington’s favorite ploys – requiring the states to do something, but not paying for it. In this instance, it is the expansion of Medicaid to cover all persons up to 133% of the federal poverty line. Although Congress offers short-term relief for the increased expenditure, that ends in 2017 and the states eventually pick up most of the tab – or face losing all of their federal funding for Medicaid. The Court ruled that if the Feds want to expand Medicaid that way, they need to pick up the full tab – permanently.
“The Medicaid expansion thus violates the Constitution by threatening States with the loss of their existing Medicaid funding if they decline to comply with the expansion. The constitutional violation is fully remedied by precluding the Secretary from applying §1396c to withdraw existing Medicaid funds for failure to comply with the requirements set out in the expansion.”
Taken broadly, this opens a Pandora’s box of mandates to legal challenges, in everything from education (“No Child Left Behind”) to transportation (Federal Highway Funding). Fun times lie ahead, I’m sure.
I’ll have more in a few days, once I’ve fully digested all 193 pages of the decision. If interested, you can read the full thing here.