Tag: aca

The Hidden Costs of ObamaCare’s Millennial Mandate

Guests mingle during the second annual Future of America gala at the House of Sweden in Washington, D.C., U.S., on Friday, Oct. 3, 2014. "Our guests are not people that are traditionally struggling with unemployment," said David Pattinson, founder of David Pattinson's American Future, a Washington-based nonprofit, which aims to get the millennial generation more fully employed. Photographer: T.J. Kirkpatrick/Bloomberg

There is a current running through the ObamaCare debate that goes something like this:

Every other advanced country provides health insurance to all its citizens for a fraction of what Americans spend on health care. ObamaCare emulates what those countries do. Anyone who complains about ObamaCare increasing premiums or imposing other costs is therefore a right-wing nut who doesn’t understand that universal coverage results in lower spending, not higher spending.

This line of reasoning, so to speak, leads supporters to believe ObamaCare is a free lunch. Their ignorance is not accidental. MIT health economist and ObamaCare architect Jonathan Gruber helpfully explained some years ago that he and his co-architects deliberately designed the law to hide its costs and make the benefits seem like a free lunch.

ObamaCare’s “Millennial mandate”—the requirement that employers who offer health coverage for employees’ dependents continue to offer such coverage until the dependents turn 26 years old—is one of those supposed free lunches. This mandate’s benefits unquestionably come at a cost. Expanding health insurance coverage among adults age 19-26 leads them to consume more medical care. When those people file insurance claims, health-insurance premiums rise. Yet ObamaCare does an amazing job of hiding those costs from voters.

Does ObamaCare impose a special tax that the IRS collects to pay for that extra coverage? No. That would be far too transparent. The cost just gets added to your premiums.

Does ObamaCare require employers to include a line-item on your premium payments, to show you how much this additional coverage is costing you? Absolutely not. That, too, would make the costs dangerously noticeable. The additional cost just gets thrown onto the pile, hidden among the costs of all the other mandated coverage you don’t want, and the coverage you actually do want.

Maybe workers see their premiums rising, and are merely ignorant of the fact that the Millennial mandate is part of the reason? Nope. ObamaCare hides the cost further still. Explaining how requires a little bit of labor economics.

The ACA’s Sixth Anniversary Is A Wake, Not A Birthday Party

Six years ago today, President Barack Obama gave the Affordable Care Act his signature. There is no sense in marking the ACA’s anniversary, however, because the ACA is no longer the law.

Realizing the law he signed was unconstitutional and unworkable. President Obama and the Supreme Court have since made a series of dramatic revisions that effectively replaced the ACA with something we now call “ObamaCare.”

ObamaCare–not the ACA–is the law under which Americans now live.

  • Under ObamaCare, the Supreme Court used Congress’ taxing power–a power Congress declined to use under the ACA–to force Americans to purchase government-approved health-insurance plans.
  • Under ObamaCare, the Supreme Court severed the connection between the (ineffective) Medicaid expansion Congress enacted and the rest of the Medicaid program–a bifurcation Congress never contemplated, much less intended.
  • Under ObamaCare, the president imposed and the Supreme Court green-lighted taxes on nearly 100 million Americans whom Congress clearly exempted.
  • ObamaCare gives members of Congress a special exemption from the ACA. (It’s good to be the king.)
  • Under ObamaCare, the president can tax and subsidize whom he pleases. Even if Congress didn’t provide the funding. Even if Congress says he can’t.

The ACA, in effect, is dead. ObamaCare is the law governing Americans’ health care–even if we don’t know what that law is from one day to the next. The ACA had legitimacy. No legislature ever approved ObamaCare. It has no legitimacy.

Unfortunately, ObamaCare doesn’t work much better than the ACA. ObamaCare is still causing Americans to lose their health plans. As one voter pointedly reminded Hillary Clinton, ObamaCare is still driving premiums higher. It is still causing their coverage to erode.

If you want to celebrate something on March 23, celebrate the anniversary of the last time Democrats put the legislative process and political legitimacy ahead of their ideological goal of universal coverage

More Losses Ahead for Obamacare’s Troubled CO-OPs

Twelve of the 23 Obamacare health cooperatives (CO-OPs) have shut down already. 627,000 people were enrolled in CO-OPs that ceased operations, and the federal government had disbursed more than $1.2 billion to these CO-OPs, and it might be difficult to ever recover any of these taxpayer funds. A GAO report released this week reveals that the CO-OP losses could be far from over.

4 of the 11 CO-OPs still operating in 2016 have not yet reached the benchmark of 25,000 enrollees, which CMS officials say is the minimum needed for a CO-OP to have financial solvency. More than 69,000 people were enrolled in these plans as of January 2016, and the federal government has already disbursed $265 million of the $407.8 million in loans awarded to them. The people enrolled in these plans and millions of dollars in government outlays are both at risk in the coming year. The map below, based on a figure from the report, shows how level of attrition so far, with the addition of highlighting the states where the CO-OPs have failed to reach the enrollment benchmark.

Interview with John Goodman on How to Replace ObamaCare

Last year, the Cato Institute held a forum on John Goodman’s latest book on health reform, A Better Choice: Healthcare Solutions for America (Independent Institute, 2015). Goodman founded and was the longtime president and CEO of the National Center for Policy Analysis. The Wall Street Journal calls him “the father of health savings accounts,” and he is currently president of the Goodman Institute for Public Policy Research and a senior fellow at the Independent Institute. Video of the book forum is available here.

I posted a lightly edited transcript of my interview of Goodman, which did a good job of highlighting the differences among ObamaCare opponents, in three parts:

For more on the three schools of ObamaCare opponents, see Cato’s previous book forum on Philip Klein’s Overcoming Obamacare: Three Approaches to Reversing the Government Takeover of Health Care (Washington Examiner, 2015).

Hillary Clinton’s Answer On Rising ObamaCare Premiums

As the number of people enrolling in ObamaCare Exchanges is falling below the Obama administration’s targets, Hillary Clinton faced a tough question at a town hall meeting in Ohio on Sunday night. Theresa O’Donnell, a Democratic-leaning voter complained that ObamaCare caused her family’s health insurance premiums to double from $5,880 per year to $12,972 per year. “I would like to vote Democratic, but it’s costing me a lot of money,” O’Donnell pleaded. “I am just wondering if Democrats really realize how difficult it’s been on working-class Americans to finance ObamaCare.” The audience applauded O’Donnell, showing once again that, really, not even Democrats like ObamaCare.

A Long-Overdue Conversation about How to Replace ObamaCare

With the prospect of a Republican president who could conceivably repeal and replace ObamaCare, it is time for ObamaCare opponents to take a hard look at their “replace” plans. As I have argued elsewhere, expanding health savings accounts – a proposal I call Large HSAs – beats other alternatives like health-insurance tax credits. In short, if opponents succeed in repealing ObamaCare, Large HSAs would take another step in the direction of a market system. Health-insurance tax credits would constitute a step backward, because they would simply resurrect some of ObamaCare’s worst features–including an individual mandate and much of ObamaCare’s government spending and redistribution.

I set off a kerfuffle last week when I wrote that Sen. Marco Rubio’s (R-FL) ObamaCare replacement plan contains an individual mandate in the form of tax credits for health insurance. Rubio supporters and others were none too pleased. 

John Kasich’s ObamaCare Duplicity

Ohio governor and GOP presidential hopeful John Kasich says he opposes ObamaCare. Yet somehow, he has managed to embrace the law in every possible way. He wanted to implement an Exchange, even if it was clearly unconstitutional under Ohio law. He denounced the Medicaid expansion’s “large and unsustainable costs,” which “will just rack up higher deficits…leaving future generations to pick up the tab.” Then he went ahead and implemented it anyway. Worse, he did so unilaterally, after the Ohio legislature passed legislation prohibiting him from doing so (which he vetoed). When Republican legislators and pro-life groups filed suit to stop him, Kasich defended his power-grab all the way to the Ohio Supreme Court. 

Kasich’s defense of his record on ObamaCare has been…less than honest. Just one example: in a town hall meeting in South Carolina last night, Kasich railed against how ObamaCare increases the cost of health care at the same time he boasted he has constrained Medicaid spending in Ohio. In fact, Kasich’s unilateral Medicaid expansion not only increased the cost of Medicaid to taxpayers nationwide, but according to Jonathan Ingram of the Foundation for Government Accountability, it “has run $2.7 billion over budget so far [and] is set to run $8 billion over budget by 2017.” 

For more examples of Kasich’s ObamaCare duplicity, see my new four-part (yet highly readable!) series at DarwinsFool.com: