Tag: health insurance reform

It’s Official: Governors Implementing ObamaCare Are Undermining the Lawsuits

Judge Roger Vinson of the U.S. District Court for the Northern District of Florida has just responded to the Obama administration’s “motion to clarify” his prior ruling, which declared ObamaCare unconstitutional and void.  That “motion to clarify” essentially asked Vinson, “Didn’t you really mean that we can keep implementing ObamaCare while we appeal your ruling?”  Today, Vinson answered, “No.”

The attorneys representing the plaintiffs, who include Florida and 25 other states, argued that the administration’s “motion to clarify” was actually a veiled request to have Vinson stay (i.e., set aside) his original order blocking implementation.  Vinson agreed, and therefore treated the Obama administration’s “motion to clarify” as a motion to stay, which he granted.  Vinson made clear, however, that if the administration fails to file a notice of appeal by March 10 or fails to seek an expedited appeal either with the 11th Circuit Court of Appeals or the Supreme Court, then his stay will lift and the administration will (once again) be barred from implementing or enforcing ObamaCare.  In other words, Vinson prevented the Obama administration from treating his stay as an excuse to ignore his ruling while the further entrenching the law.

It would have been better if Vinson had stuck to his original order blocking implementation.  Yet he made clear that one of the reasons he did not is that many of the states asking him to strike down the law are implementing it anyway.  Vinson wrote that the case for blocking implementation:

is undercut by the fact that at least eight of the plaintiff states…have represented that they will continue to implement and fully comply with the Act’s requirements — in an abundance of caution while this case is on appeal — irrespective of my ruling.

As the Obama administration explained to the court:

[S]ince the Court entered its judgment on January 31, at least 24 of the 26 plaintiff states have applied for additional grants authorized or appropriated by the ACA, continued to draw down grant funds previously awarded under the ACA, or otherwise availed themselves of resources made available by the ACA. Indeed, South Carolina has continued to drawn down exchange planning grant funds, even though it has declared the Act “void and unenforceable.” Similarly, Utah has described the declaratory judgment as an “injunction against further implementation” of the Act, but has continued to draw down Pre-existing Condition Insurance Plan (“PCIP”) funds and to request Early Retiree Reinsurance Program (“ERRP”) reimbursements.

Now would be a good time for the South Carolina Gov. Nikki Haley (R), Utah Gov. Gary Herbert (R), and the governors of the other 22 plaintiff states to join Alaska and Florida in refusing to accept any further ObamaCare funds, returning the ObamaCare funds they have already received, and ceasing all implementation activities, including “planning” efforts.

Tea partiers and other conservative groups turned on House Republicans in a dispute over when the House would vote to cut off all ObamaCare spending.  Where’s the outrage over the governors and state legislators that are eagerly pursuing that funding, actively implementing the law, and preventing judges from stopping implementation?

Two Reasons Governors Should Stop Implementing ObamaCare

The Washington Post reports:

Practically every week, a Republican governor or lawmaker announces a new effort to kill the health-care law or undercut its implementation.

Unfortunately, many of those same governors are still implementing the law when they should be outright refusing to do so.

In my Kaiser Health News column today, I offer two reasons why (at least) Republican governors should stop implementing ObamaCare:

Swearing an oath to support the Constitution also obligates governors to use lawful means to prevent its unlawful abuse. Governors who believe ObamaCare to be unconstitutional are as duty-bound to stop implementing the law as they are to challenge it in court…

It is the height of fiscal irresponsibility to be making new spending commitments (1) when the federal deficit is $1.5 trillion and state budget deficits are a cumulative $175 billion, (2) when those new commitments create a framework for a massive new entitlement program, and (3) when that new spending comes under the auspices of a law that has been invalidated by one federal court and may be invalidated by the nation’s highest court.

So far, the only governors I’ve seen take a firm stand against implementing the law are Rick Scott (R-FL) and Sean Parnell (R-AK), who respectively govern the fourth-largest and the fourth-smallest states.  (Disclosure: I served on Rick Scott’s transition team.)

ObamaCare Regs’ Effect on Uncompensated Care Overblown

An Obama administration “fact sheet,” released alongside the interim final rules for several of ObamaCare’s cost-increasing mandates, claims those mandates will reduce the “hidden tax” imposed by uncompensated care:

By making sure insurance covers people who are most at risk, there will be less uncompensated care and the amount of cost shifting among those who have coverage today will be reduced by up to $1 billion in 2013.

According to research by the Urban Institute, that “hidden tax” isn’t very large:

Private insurance premiums are at most 1.7 percent higher because of the shifting of the costs of the uninsured to private insurers in the form of higher charges.

As the Congressional Budget Office repeatedly lectures Congress, “Uncompensated care is less significant than many people assume.”

Likewise, these mandates’ effect on uncompensated care will be less significant than the Obama administration would like you to think.  Using data from the Centers for Medicare & Medicaid Services and a reasonable assumption of 6-percent annual growth, total private health insurance premiums in 2013 will be in the neighborhood of $1.1 trillion.  So the administration is boasting that these mandates will reduce the 1.7-percent “hidden tax” imposed by uncompensated care to 1.61 percent.

Indeed, the whole of ObamaCare may not do much to reduce the “hidden tax” of uncompensated care. After Massachusetts enacted a nearly identical law, the Urban Institute reports, “high levels of emergency department (ED) use have persisted in Massachusetts. Specifically, ED use was high in Massachusetts prior to health reform and has stayed high under health reform.”  A lot of uncompensated care comes in through the ED.

Finally, notice how a 1.7-percentage-point premium surcharge is a bad thing if President Obama is ostensibly rescuing you from it, but a good thing if he’s imposing it on you.

A Transparency Reality Check

David Axelrod, senior adviser to President Obama, emailed me yesterday (along with perhaps several million others) to tell me about a new effort on Whitehouse.gov to dispel “rumors and scare tactics” from people opposing even more government regulation of the health sector. I think the opponents of expanded regulation have the better arguments on the merits.

transparency reality checkI was struck, though, by the effort that has gone into creating an entirely new section of Whitehouse.gov for a “Health Insurance Reform Reality Check,” complete with fancy graphics and videos. (I have modified one of those graphics to illustrate this post. Fun!) Meanwhile, the White House still hasn’t brought itself to do something that President Obama promised on the campaign trail: post bills online for five days before signing them.

Since I last updated the chart, President Obama has signed seven more bills. None of them were posted online for five days, though two were held at the White House for that long before they got the president’s signature.

It’s the president’s prerogative to use Whitehouse.gov for PR, of course. The site and the PR on it would have more legitimacy, though, if it were also a basic resource for information about the legislative business the president conducts — as he promised.

Because the White House has established no uniform location for posting bills, there’s always a chance that I missed postings. I welcome corrections.

In my search for posted bills I did find this blog post, which says “The President believes that a piece of legislation as important as the Recovery Act must be implemented with an unprecedented degree of transparency.” But as you can see below, he denied the public a chance to review the Recovery Act as he promised, making it Public Law 111-5 within a day of its presentment.

Public Law Date Presented Date Signed Posted (Linked) for Comment? Five Days?
P.L. 111-2, The Lilly Ledbetter Fair Pay Act of 2009 1/28/2009 1/29/2009 1/29/2009 No
P.L. 111-3, The Children’s Health Insurance Program Reauthorization Act of 2009 2/4/2009 2/4/2009 2/1/2009 No
P.L. 111-4, The DTV Delay Act 2/9/2009 2/11/2009 2/5/2009 Yes and No
P.L. 111-5, The American Recovery and Reinvestment Act of 2009 2/16/2009 2/17/2009 2/13/2009 No
P.L. 111-6, Making further continuing appropriations for fiscal year 2009, and for other purposes 3/6/2009 3/6/2009 No n/a
P.L. 111-7, A bill to designate the facility of the United States Postal Service located at 2105 East Cook Street in Springfield, Illinois, as the “Colonel John H. Wilson, Jr. Post Office Building” 2/26/09 3/9/2009 No n/a
P.L. 111-8, The Omnibus Appropriations Act, 2009 3/11/2009 3/11/2009 3/6/2009 No
P.L. 111-9, To extend certain immigration programs 3/18/2009 3/20/2009 No n/a
P.L. 111-10, To provide for an additional temporary extension of programs under the Small Business Act and the Small Business Investment Act of 1958, and for other purposes 3/19/2009 3/20/2009 No n/a
P.L. 111-11, The Omnibus Public Land Management Act of 2009 3/30/2009 3/30/2009 3/30/2009 No
P.L. 111-12, The Federal Aviation Administration Extension Act of 2009 3/24/2009 3/30/2009 No n/a
P.L. 111-13, The Generations Invigorating Volunteerism and Education Act 4/20/2009 4/21/2009 No n/a
P.L. 111-14, To designate the United States courthouse under construction at 327 South Church Street, Rockford, Illinois, as the “Stanley J. Roszkowski United States Courthouse” 4/14/2009 4/23/2009 No n/a
P.L. 111-15, The Special Inspector General for the Troubled Asset Relief Program Act of 2009 4/14/2009 4/24/2009 No n/a
P.L. 111-16, The Statutory Time-Periods Technical Amendments Act of 2009 4/30/2009 5/7/2009 No n/a
P.L. 111-17, A joint resolution providing for the appointment of David M. Rubenstein as a citizen regent of the Board of Regents of the Smithsonian Institution 4/28/2009 5/7/2009 No n/a
P.L. 111-18, A bill to repeal section 10(f) of Public Law 93-531, commonly known as the “Bennett Freeze” 4/28/2009 5/8/2009 No n/a
P.L. 111-19, The Civil Rights History Project Act of 2009 4/30/2009 5/12/2009 No n/a
P.L. 111-20, The Protecting Incentives for the Adoption of Children with Special Needs Act of 2009 5/5/2009 5/15/2009 No n/a
P.L. 111-21, The FERA 5/19/2009 5/20/2009 No n/a
P.L. 111-22, The Helping Families Save Their Homes Act of 2009 5/20/2009 5/22/2009 No n/a
P.L. 111-23, The Weapon Systems Acquisition Reform Act of 2009 5/21/2009 5/22/2009 5/14/2009 No
P.L. 111-24, The Credit Cardholders’ Bill of Rights Act of 2009 5/20/2009 5/22/2009 5/14/2009 No
P.L. 111-25, The Ronald Reagan Centennial Commission Act 5/21/2009 6/2/2009 No n/a
P.L. 111-26, To designate the facility of the United States Postal Service located at 12877 Broad Street in Sparta, Georgia, as the “Yvonne Ingram-Ephraim Post Office Building” 6/9/2009 6/19/2009 No n/a
P.L. 111-27, To designate the facility of the United States Postal Service located at 300 East 3rd Street in Jamestown, New York, as the “Stan Lundine Post Office Building” 6/9/2009 6/19/2009 No n/a
P.L. 111-28, To designate the facility of the United States Postal Service located at 103 West Main Street in McLain, Mississippi, as the “Major Ed W. Freeman Post Office” 6/9/2009 6/19/2009 No n/a
P.L. 111-29, To designate the facility of the United States Postal Service located at 3245 Latta Road in Rochester, New York, as the “Brian K. Schramm Post Office Building” 6/9/2009 6/19/2009 No n/a
P.L. 111-30, The Antitrust Criminal Penalty Enhancement and Reform Act of 2004 Extension Act 6/19/2009 6/19/2009 No n/a
P.L. 111-31, The Family Smoking Prevention and Tobacco Control Act 6/16/2009 6/22/2009 No n/a
P.L. 111-32, The Supplemental Appropriations Act, 2009 6/19/2009 6/24/2009 No n/a
P.L. 111-33, The Native American Heritage Day Act of 2009 6/16/2009 6/26/2009 No n/a
P.L. 111-34, To designate the Federal building and United States courthouse located at 306 East Main Street in Elizabeth City, North Carolina, as the “J. Herbert W. Small Federal Building and United States Courthouse” 6/19/2009 6/30/2009 No n/a
P.L. 111-35, To designate the Federal building located at 799 United Nations Plaza in New York, New York, as the “Ronald H. Brown United States Mission to the United Nations Building” 6/19/2009 6/30/2009 No n/a
P.L. 111-36, The Webcaster Settlement Act of 2009 6/19/2009 6/30/2009 No n/a
P.L. 111-37, The Veterans’ Compensation Cost-of-Living Adjustment Act of 2009 6/25/2009 6/30/2009 No n/a
P.L. 111-38, A bill to provide additional personnel authorities for the Special Inspector General for Afghanistan Reconstruction 6/24/2009 6/30/2009 No n/a
P.L. 111-39, To make technical corrections to the Higher Education Act of 1965, and for other purposes 6/26/2009 7/1/2009 No n/a
P.L. 111-40, A bill to award a Congressional Gold Medal to the Women Airforce Service Pilots (”WASP”) 6/24/2009 7/1/2009 No n/a
P.L. 111-41, The Korean War Veterans Recognition Act 7/27/2009 7/27/2009 No n/a
P.L. 111-42, Approving the renewal of import restrictions contained in the Burmese Freedom and Democracy Act of 2003, and for other purposes 7/27/2009 7/28/2009 No n/a
P.L. 111-43, A bill to provide for an additional temporary extension of programs under the Small Business Act and the Small Business Investment Act of 1958, and for other purposes 7/30/2009 7/31/2009 No n/a
P.L. 111-44, The New Frontier Congressional Gold Medal Act 7/27/2009 8/7/2009 No n/a
P.L. 111-45, To authorize the Director of the United States Patent and Trademark Office to use funds made available under the Trademark Act of 1946 for patent operations in order to avoid furloughs and reductions-in-force, and for other purposes 7/27/2009 8/7/2009 No n/a
P.L. 111-46, To restore sums to the Highway Trust Fund, and for other purposes 8/4/2009 8/7/2009 No n/a
P.L. 111-47, Making supplemental appropriations for fiscal year 2009 for the Consumer Assistance to Recycle and Save Program 8/6/2009 8/7/2009 No n/a

Market Bets that ObamaCare Won’t Cut Costs

According to Don Johnson of The Health Care Blog:

Speculators seem to be betting that a watered down health insurance reform bill won’t hurt health insurers, hospitals, drug makers or medical device and supply manufacturers.

Stocks for almost all of these health sectors and for exchange trade funds that track health stock indexes turned higher last week.

In other words, those with real money at stake don’t believe that health reform will hurt the firms that make a living off of America’s highly inefficient health sector – President Obama’s assurances notwithstanding.

Johnson provides seven possible explanations for this development, including:

3. If the very liberal Coastal Democrats who lead Congress and most of the five committees drafting health insurance legislation want to get the support of Democrats from Western, Midwestern and Southern states, they’ll have to up Medicare payments to providers in those states. This is bullish for hospital chains, which operate mostly in the fly-over states…

6. Proposals to tax millionaires to pay for covering the uninsured and increasing benefits for others are in trouble, if not dead on arrival.  The economy’s in no shape to be stalled by tax hikes, and there appear to be enough Democrats opposed to the tax to stop it.

7. While the so-called Blue Dog Democrats are stalling health insurance reform for economic and ideological reasons, the Congressional Black Caucus has made it clear that it won’t support a bill that the Blue Dogs will support. Throw in the opposition by anti-abortionists who don’t want the legislation to use taxpayers money to pay for abortions, and you have a pretty complex political problem for President Obama, Sen. Majority Leader Harry Reid (D-NV) and Speaker Nancy Pelosi (D-CA). While the Speaker claimed Sunday that she has the votes to pass health insurance reform, few believe her.

“Fascinating ‘Outside-of-the-Box’ Thinking on Health Insurance Reform”

At Reason Online, Ronald Bailey reviews John Cochrane’s recent Cato Policy Analysis, “Health-Status Insurance: How Markets Can Provide Health Security.”

Writing in advance of last week’s health care summit held by President Obama, Bailey explains:

Summit attendees will break into various working groups that are supposed to engage in “outside-of-the-box” thinking. As it happens, they now have some fascinating “outside-of-the-box” thinking on health insurance reform to draw on. Earlier this month, University of Chicago economist John Cochrane published an intriguing policy analysis for the libertarian Cato Institute that looked at how “health-status insurance” can provide health security for Americans. Cochrane claims that with health-status insurance, free markets can solve the vexing problem of how to insure people with pre-existing medical conditions and “provide life-long, portable health security, while enhancing consumer choice and competition.”…

Creating and selling separate health-status insurance policies would mean that medical insurance companies would no longer have an incentive to offload sick people. Instead, because those with pre-existing conditions would have the funds to pay higher premiums, insurers would compete for their business. “Constant competition for every consumer will have the same dramatic effects on cost, quality, and innovation in health care as it does in every other industry,” argues Cochrane.

Health-status insurance also helps delink medical insurance from employment because…a worker diagnosed with diabetes…can switch jobs without worrying about whether or not he can obtain medical insurance…

While Cochrane acknowledges that his proposal is not a comprehensive health care reform program, adopting it would go a long way toward satisfying President Obama’s eight health care reform principles, especially affordability, aiming toward universality, portability, and choice, and being fiscally sustainable. “Health-status insurance can simultaneously give us complete and portable long-term insurance, great individual choice, and cost-containment beyond the dreams of any health policy planner,” concludes Cochrane. Asked if he has been invited to the president’s health care reform summit this week, Cochrane said no, but quickly added, “If I got the phone call, I would definitely be there.” Mr. President, there’s still time for your summiteers to hear about this outside-of-the-box thinking.