Tag: medicaid

At First Anniversary, ObamaCare on the Run

One year ago today, President Barack Obama signed ObamaCare into law. I recap ObamaCare’s first year in my latest Kaiser Health News column. Here’s some additional news surrounding the law’s anniversary.

Politico reports that supporters won’t have the vast war chest to defend the law that they once said they would:

Democrats are under siege as they mark the first anniversary of health care reform Wednesday — and they won’t get much help from the star-studded, $125 million support group they were once promised…[N]ine months later, the Health Information Campaign has all but disappeared. Its website hasn’t been updated since the end of last year. Its executive director and communications director are gone. There’s no sign that it has any money. And neither [former senator Tom] Daschle nor [former White House Communications Director Anita] Dunn will return calls asking about it.

Politico also reports on what everyone knows, but few reporters seem willing to say.  ObamaCare is unpopular, and growing more so:

Although Democrats insisted that the [law] would become more popular once the congressional debate ended and the benefits started to kick in, the reverse has actually happened. According to a Kaiser Health Tracking poll released Friday, 46 percent of the public opposes the law, up from 40 percent a year ago. Only 42 percent support the law, down from 46 percent a year ago.

Finally, Politico (again) reports that yet another governor – Louisiana’s Bobby Jindal (R) – has refused to implement ObamaCare:

The Louisiana governor’s office gave PULSE the first definitive answer on whether it would run its own health exchange, and it took them only two letters: no. “Obamacare is a terrible policy that needs to be repealed and replaced,” Gov. Bobby Jindal’s press secretary Kyle Plotkin tells PULSE. “It creates enormous new costs and future unfunded liabilities for states financing their Medicaid programs.” That puts him in a similar camp with Florida Gov. Rick Scott, who recently told us that Florida is “not doing anything with regards to the exchange, I don’t believe in the exchange. It doesn’t do anything to improve access to care. It does nothing to drive down health care costs.”

It’s worth emphasizing that Scott and Jindal probably know more about health care than the other 48 governors.

This Week in Government Failure

Over at Downsizing the Federal Government, we focused on the following issues this week:

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Congressional Republicans May Be Understating the Cost of ObamaCare

Yesterday, the Senate Finance and House Energy & Commerce committees released a joint report on the costs that ObamaCare’s Medicaid mandate will impose on states.  That report, which is based on other reports, likely understates the cost of that unfunded mandate.

In a new Cato Working Paper, “Estimating ObamaCare’s Effect on State Medicaid Expenditure Growth,” senior fellow Jagadeesh Gokhale constructed cost projections for the five largest states – California, Florida, Illinois, New York, and Texas – which account for 40 percent of the nation’s population.  Gokhale carefully decomposed and organized micro-data and state-specific administrative data on Medicaid eligibility, enrollments, benefit recipiency, and average benefits per recipient.  Gokhale found much larger cost burdens than the committees’ projections.  

For example, Gokhale projects that ObamaCare will force Florida to spend an additional $20.4 billion between 2014 and 2023. That is almost double the committees’ estimate of an additional $12.9 billion in spending by Florida between 2013 to 2023.

Obama Offers States ‘Flexibility’ to Adopt Single-Payer instead of ObamaCare

The New York Times reports:

Seeking to appease disgruntled governors, President Obama plans to announce on Monday that he supports amending the 2010 health care law to allow states to opt out of its most burdensome requirements three years earlier than currently permitted.

It’s significant that the president is finally acknowledging that ObamaCare is unworkable and will impose enormous burdens on the states.  Or is he?

A closer look shows that the president is not lifting the burdensome requirements ObamaCare imposes on states.  All he’s doing is proposing to move up, from 2017 to 2014, the date on which states can apply for federal permission to impose a different but equivalently or more coercive plan to expand health insurance coverage.  Here’s what the Times says about the legislation Obama will reportedly endorse, which was introduced by Sens. Ron Wyden (D-OR) and Scott Brown (R-MA):

The legislation would allow states to opt out earlier from various requirements if they could demonstrate that other methods would allow them to cover as many people, with insurance that is as comprehensive and affordable, as provided by the new law. The changes also must not increase the federal deficit.

If states can meet those standards, they can ask to circumvent minimum benefit levels, structural requirements for insurance exchanges and the mandates that most individuals obtain coverage and that employers provide it. Washington would then help finance a state’s individualized health care system with federal money that would otherwise be spent there on insurance subsidies and tax credits.

So states can “opt out” of ObamaCare’s individual mandate if they cover as many people, with as many benefits, and as many government subsidies, as ObamaCare would.  The Times quotes “administration officials” on how states might do that:

The administration officials said the so-called state innovation waivers in the Wyden-Brown bill might allow a state to experiment with ways to entice people to obtain insurance rather than requiring them to buy policies. It also might allow interested states to establish a single-payer system in which the government is the sole insurer. Gov. Peter Shumlin, a newly elected Democrat in Vermont, is pursuing such a proposal.

No such state plan can make a dent in the federal laws that are fueling the relentless growth in the cost of health care (see Medicare, the federal tax treatment of health care, etc.).  Therefore, the only way that states could cover as many people as ObamaCare does is by using ObamaCare’s tactic of forcing people to buy exorbitantly costly health insurance.  And if they’re not going to use an individual mandate, the only remaining option is a single-payer health care system.

President Obama’s move is not about giving states more flexibility.  It’s about moving the nation even faster toward his ideal of a Canadian- or British-style single-payer health care system.

Opposition to ObamaCare Hits New High in Kaiser Family Foundation Poll

The following chart shows that ObamaCare’s unfavorables reached 50 percent in the latest Kaiser Family Foundation poll.  That’s higher than at any point since KFF started tracking ObamaCare’s unfavorables in January 2010.  The KFF poll also found that opposition is much more intense than support; 19 percent view the law very favorably, while 34 percent view the law very unfavorably.  Despite the availability of the these nuggets, KFF’S press release chose to deemphasize the surge: “Americans Remain Divided Over Health Reform With An Uptick In Public Opposition As GOP Ramped Up Repeal Campaign.”

Even more entertaining was this chart, which purports to show that Americans oppose defunding ObamaCare by nearly 2-to-1.

Dig a little deeper, though, and you’ll find that 16 percent of the public opposes defunding ObamaCare because they want to see the law flat-out repealed.  A less-misleading pie chart would show that 33 percent approve of defunding, 16 percent say “don’t defund, just repeal” (total: 49 percent), and 46 percent disapprove of defunding ObamaCare.

Other findings include:

  • 76 percent of the public oppose the individual mandate (and 55 percent oppose it even after hearing arguments for and against);
  • 69 percent support cutting spending on ObamaCare’s coverage expansions;
  • 60 percent believe ObamaCare will increase the deficit, while only 11 percent believe it will reduce the deficit;
  • 52 percent support cutting Medicaid;
  • 51 percent oppose ObamaCare’s employer mandate; and
  • 51 percent oppose ObamaCare’s new taxes on over-the-counter medications for HSA, FSA, and HRA holders.

Despite these generally sensible views, 68 percent believe that Congress can balance the budget without cutting Medicare.

Talk of Replacing ObamaCare Is a Bit Premature

Now that a bipartisan coalition in the House has voted to repeal ObamaCare, an even larger bipartisan coalition has approved a Republican resolution directing four House committees to “replace” that ill-fated law.  House Resolution 9 instructs the committees to “propos[e] changes to existing law” with the following goals:

  1. “Foster economic growth and private sector job creation by eliminating job-killing policies and regulations.”
  2. “Lower health care premiums through increased competition and choice.”
  3. “Preserve a patient’s ability to keep his or her health plan if he or she likes it.”
  4. “Provide people with pre-existing conditions access to affordable health coverage.”
  5. “Reform the medical liability system to reduce unnecessary and wasteful health care spending.”
  6. “Increase the number of insured Americans.”
  7. “Protect the doctor-patient relationship.”
  8. “Provide the States greater flexibility to administer Medicaid programs.”
  9. “Expand incentives to encourage personal responsibility for health care coverage and costs.”
  10. “Prohibit taxpayer funding of abortions and provide conscience protections for health care providers.”
  11. “Eliminate duplicative government programs and wasteful spending.”
  12. “Do not accelerate the insolvency of entitlement programs or increase the tax burden on Americans;” or
  13. “Enact a permanent fix to the flawed Medicare sustainable growth rate formula used to determine physician payments under title XVIII of the Social Security Act to preserve health care for the nation’s seniors and to provide a stable environment for physicians.”

Three things about the Republicans’ “replace” effort:

First, America’s health care sector has historically been handicapped by one political party committed to a policy of (mostly) benign neglect, and another party committed to degrading that sector’s performance through government subsidies, mandates, price controls, and other exchange controls.  Republicans now appear to be taking a different posture, and that’s encouraging — but not entirely.  When Republicans set their minds to reforming health care, they are often as bad as Democrats.  (See the Republican “alternatives” to ClintonCare.  Or Medicare Part D.  Or #4-#7 above.)  Exactly how House Republicans plan to deliver on the above goals remains to be seen.

Second, no matter how House Republicans plan to deliver on the above goals, their proposals will be preferable to ObamaCare.  Republicans quite literally could not do worse if they tried.

Third, no matter how good the Republicans’ proposals are, they will be utterly ineffective so long as ObamaCare remains on the books.  ObamaCare’s influence is so pervasive and harmful that it makes real health care reform all but impossible.

So it’s a bit premature to be talking about replacing ObamaCare.

House Vote to Repeal ObamaCare Is More than Mere Symbolism

The symbolism of today’s House vote is striking. Within a year of ObamaCare’s enactment, the House of Representatives has voted overwhelmingly to repeal it.

That didn’t happen with Social Security. It didn’t happen with Medicare. Social Security and Medicare did not face sustained public opposition from the moment they were introduced in Congress. They did not pass by one vote, in the dead of night. They were not challenged as unconstitutional by half the states in the union.  They were not struck down as unconstitutional by a federal court within a year of enactment.

The House vote to repeal ObamaCare is just the latest sign that ObamaCare goes too far, that it creates a more intrusive government than the American people are willing to accept.

But the House vote is not mere symbolism, as the Obama administration would have us believe.  This vote has moved the ball forward on repeal.  This and further similar votes in both the House and Senate will reveal where members stand on repealing ObamaCare.  Voters may use that information to replace pro-ObamaCare members with people who will vote to repeal ObamaCare in the next Congress.  That’s how the political system works.

At the same time, this repeal vote makes it more likely that the Supreme Court will strike down ObamaCare. Like it or not, the Supreme Court follows the election returns. This vote shows the Court that it will not pay a price in the public’s esteem if it overturns ObamaCare.

Today’s vote makes it more likely that someone with the power to scrap ObamaCare will do so – and the Obama administration knows it.  Why else would they come out with both guns blazing against a purely “symbolic” act?

When that happens, it will be a good day for America. Real health care reform is impossible while ObamaCare remains on the books.