Topic: Health Care & Welfare

New Obamacare Lawsuit Targets Arizona Gov. Brewer’s Illegal New Taxes

In 1992, after seeing their taxes raised 8 times in 9 years, the people of Arizona overwhelmingly approved Proposition 108, a ballot initiative that amended the state constitution to require tax and fee increases to be passed by a 2/3 vote in each of Arizona’s legislative bodies.  Since then, Prop 108’s supermajority requirement has protected Arizona taxpayers from the kind of special-interest-driven tax increases that typically don’t enjoy public support. As a result, Arizona’s tax burden has fallen over the years, to the state’s great economic benefit.

Recently, however, as part of a brazen effort to force through Obamacare’s Medicaid expansion, Governor Jan Brewer – who ran for reelection last year as a staunch opponent of Obamacare – sidestepped Prop 108 in a way that threatens to eviscerate its taxpayer protections and otherwise violate Arizona’s stricter-than-normal adherence to the separation of powers.

Because the Medicaid expansion will cost Arizona an untold sum, and did not receive the 2/3 majority required for it to raise the taxes to pay for itself, Brewer employed more creative means to raise Arizonans’ taxes: delegating the taxation authority to a state bureaucracy and calling it an “assessment.” This approach takes advantage of Prop 108’s exception for “fees and assessments that are authorized by statute, but are not prescribed by formula, amount or limit, and are set by a state officer or agency.” Interpreted Brewer’s way, the exception allows the legislature to delegate a taxing power to state agencies that the legislature itself doesn’t have. If read this way, the exception would forevermore swallow the rule and impose an outcome contrary to Prop 108’s stated purpose.

Accordingly, our friends at the Goldwater Institute last week filed suit in state court on behalf of state lawmakers – including Rep. Adam Kwasman, a good friend of mine who’s now the vice-chair of the Arizona House Ways & Means Committee – and their constituents, challenging the new tax as a violation of Arizona’s constitution and the state’s separation of powers.  Goldwater argues that the hidden tax violates Prop. 108’s supermajority requirement for new taxes, and that Arizona’s strict separation of powers prohibits the delegation of taxing power to an unaccountable state bureaucracy.

Goldwater is clearly in the right. Prop 108 was adopted for the plain purpose of preventing precisely this type of special interest tax-and-spend behavior – behavior the people of Arizona will be even less able to oppose if state courts determine that a bare legislative majority can delegate taxation power that it doesn’t itself possess. Brewer’s Medicaid expansion, meanwhile, threatens to take the taxing power out of Arizonans’ hands and give it to bureuacrats and the special interests that lobby them.

It will be a shame if Arizona courts permit Brewer’s newfound insistence on enabling Obamacare to effectively neuter a constitutional provision supported by more than 70% of voters. For more commentary on the case, read Josh Blackman.

This blogpost was co-authored by Cato legal associate Julio Colomba.

A Democrat Reexamines His Party’s Position on Health Care

An excerpt from David Goldhill’s new book, Catastrophic Care: How American Health Care Killed My Father – And How We can Fix It

I’m a Democrat and once held views about health care common in my party. But the more I’ve looked at our system, the more I’ve come to believe that the obsessions of our political debate – universal access, health insurance regulation, cost control – are irrelevant to the real problems that have created our mess…

[T]he frustrating reality is that despite more than sixty years of government efforts – representing the work of both political parties – we are moving further and further away from what we want. Prices are higher, more people are excluded from needed care, more excess treatments are performed, and more people die from preventable errors. Why?

Goldhill explains why at a book forum on Catastrophic Care this coming Wednesday, September 18, from 12-1:30pm at the Cato Institute. Click here to register.

Missouri Lawmakers Override Veto to Enact Good Samaritan Law

In January, Missouri legislators introduced the “Volunteer Health Services Act.” The bill expands health care access for low-income residents by eliminating the regulatory barriers Missouri previously imposed on out-of-state doctors and other clinicians who want to provide free charitable care to Missouri’s poor. Yes, every state government prevents some doctors from giving away free medical care to the poor. As I wrote in “50 Vetoes:” 

Volunteer groups like Remote Area Medical engage doctors and other clinicians from around the country to treat indigent patients in rural and inner-city areas. States often prevent these clinicians from providing free medical care to the poor because, while they are licensed to practice medicine in their own states, they are not licensed to practice medicine where Remote Area Medical is holding its clinics.

Remote Area Medical has had to turn away patients or scrap clinics in California, Florida, and Georgia…After a tornado devastated Joplin, Missouri, Remote Area Medical arrived with a mobile eyeglass lab, yet state officials prohibited the visiting optometrists from giving away free glasses.

It appears that Missouri legislators, if not the governor, have learned their lesson. The legislature approved the Volunteer Health Services Act in May, and sent it to Gov. Jay Nixon (D), who vetoed it. But yesterday, both the Missouri House and Senate voted to override the governor’s vetoMissouri now joins states like Tennessee, Illinois, and Connecticut that have enacted similar Good Samaritan laws. 

The Missouri law also shields clinicians from liability for simple negligence in malpractice actions. I’m not a really a fan of letting legislatures shield doctors from liability for their own negligence. In my view, doctors and patients should choose and adopt their own med-mal rules via contract. But this part of the law may have little effect. Missouri’s Volunteer Health Services Act still leaves clinicians liable for injuries resulting from gross negligence, and judges and juries may weaken this shield by stretching the definition of “gross” negligence.  

Rather than enact massive and unaffordable new entitlement programs like ObamaCare’s Medicaid expansion, states should follow Missouri’s lead and eliminate this and other barriers that government puts in the way of getting health care to the poor.

(HT: Patrick Ishmael of the Show-Me Institute.)

Halbig Plaintiffs Request Preliminary Injunction

Halbig v. Sebelius is one of two federal lawsuits challenging an illegal IRS rule that attempts to issue ObamaCare’s tax credits in the 34 states that have opted not to establish one of the law’s health insurance “exchanges.” Yesterday, attorneys for the Halbig plaintiffs filed a motion for a preliminary injunction, requested a hearing on that motion before October 1, and filed a second motion also seeking to expedite the case. The first motion requests:

an Order enjoining [the government], pending resolution of the litigation, from applying the IRS regulations extending eligibility for premium assistance subsidies under the Patient Protection and Affordable Care Act to individuals who purchase health coverage through Exchanges established by the federal government.

If the court grants that request, ObamaCare implementation will come to a screeching halt.

The Halbig plaintiffs make a compelling case that the IRS is violating federal law, and that the court must resolve the issue before January 1, 2014. If a resolution comes after that date, the plaintiffs will be irreparably injured because they “will be forced either to comply with the ACA’s individual mandate or risk incurring a penalty, and…will further be entirely and forever precluded from purchasing catastrophic coverage for 2014.” In addition: 

the balance of the equities and public interest both cut strongly in favor of resolving the legal validity of the IRS Rule now, before billions of taxpayer dollars are illegally expended and before employers make unalterable benefit decisions premised on the Rule. If a ruling invalidating the IRS Rule is delayed until after these events, the result would be utter chaos…It serves everyone’s interests—those of Plaintiffs, the Government, and the public alike—to obtain a prompt ruling on the legal validity of the IRS Rule, so that there will be no need subsequently to confront the logistical nightmare of trying to unscramble and undo the unlawful expenditure of billions of federal dollars. [Emphasis in original.]

Even if the government ultimately prevails, as health-benefits expert Thomas Haynes explains in a supplemental filing, it would unnecessarily and irreparably injure some employers and employees if that happens in 2014 instead of 2013. Brokers who are aware that the availability of these tax credits is uncertain in 34 states will counsel employers not to adjust their employee benefits to take advantage of that still-uncertain new landscape. Those employers and employees would then be locked into spending more on health insurance in 2014 than they would if the litigation had been resolved in 2013. 

The Obama administration, however, is in no hurry. In Halbig, for example, government lawyers have blown through the legal deadlines for responding to key plaintiff motions, deadlines that passed months ago. Indeed, they appear to be using every tactic at their disposal to guarantee these cases will not be resolved this year.

Whether the Obama administration’s lawyers simply have a lot on their plate, or are intentionally trying to prejudice judges against ruling for the plaintiffs – by guaranteeing that such a ruling would result in maximum chaos – a preliminary injunction is in order. 

Are Democrats and Republicans Colluding to Preserve Congress’ Obamacare Exemption?

I have written about the special (and illegal) Obamacare exemption the president has granted Congress.

It turns out, this exemption polls poorly. Opposition is north of 90 percent, unites Obamacare opponents and supporters, and has the potential to oust incumbents members of Congress who accept an special exemption that other Americans don’t get.

You might think that Republican and Democratic party committees would be salivating at the prospect of using this issue to oust incumbents of the other party. At a minimum, you would think that Obamacare opponents (i.e., Republicans) would drive a wedge between the law’s supporters (i.e., Democrats) and the public by forcing supporters to vote on a measure eliminating the exemption. Doing so could elect more new Republicans in 2014 by allowing them attack incumbent Democrats thus: “My opponent voted for Obamacare, and then voted to give himself and his well-paid friends in Congress a special exemption that the people of this state/district don’t get. That’s just wrong.”

Yet it appears the National Republican Senatorial Committee and the Democratic Senatorial Campaign Committee have negotiated a truce on this issue. If true, both parties have agreed not to give voice to the will of the people by attacking members of the other party who consent to this special privilege granted to members of Congress. If true, it would confirm what I have written previously: “America has a two-party system. But it’s not Republicans versus Democrats. It’s the ruling class — Republicans and Democrats — against everyone else.”

I can hardly imagine a more powerful argument for allowing unlimited spending by independent groups to advocate the election or defeat of political candidates. That is, I can hardly imagine a more powerful argument against “campaign finance reform.”

The New Republic: Obama Kinda Lied a Little about Obamacare

On Monday, The New Republic’s Jonathan Cohn admitted that President Obama “made a misleading statement about Obamacare rates” during his press conference on Friday. The magazine’s Twitter feed (@tnr) announced:

Whoops! The president (accidentally, we think) told a little #Obamacare lie on Friday.

During his press conference, the president said:

[When it comes to people without access to employer-sponsored coverage,] they’re going to be able to go on a website or call up a call center and sign up for affordable quality health insurance at a significantly cheaper rate than what they can get right now on the individual market. And if even with lower premiums they still can’t afford it, we’re going to be able to provide them with a tax credit to help them buy it. [Emphasis added.]

The problem, Cohn writes, is that:

while some people will pay less than they pay today, some will pay more. They will primarily be young, healthy men who benefited from preferential pricing in the past, were content with coverage that had huge gaps, and are too wealthy to qualify for the law’s tax credits—which are substantial but phase out at higher incomes…

But somebody listening to Obama’s press conference probably wouldn’t grasp that distinction. They’d come away thinking their insurance will be cheaper next year. For some, it won’t be. Obama isn’t doing himself, or the law, any favors by fostering a false expectation.

Big Business Gets Yet Another Obamacare Delay That Individuals Don’t

“I didn’t simply choose to delay this on my own,” President Obama reassured the nation about his unilateral decision to delay Obamacare’s employer mandate. “This was in consultation with businesses all across the country,” he said, as if that made the situation better instead of worse. Obama threw his “consultants” another bone when he decided to delay the reporting requirements the law imposes on employers, also until 2015. The president’s generosity toward large corporations will be financed by the American taxpayer. The Congressional Budget Office projects these delays will cost taxpayers another $3 billion in new government spending and reduce federal revenues by $9 billion, for a total increase in the federal debt of $12 billion. Yet the president fails to show the same concern for individual taxpayers. When the House of Representatives, including dozens of Democrats, voted to extend the same break to individuals by delaying Obamacare’s individual mandate by one year, President Obama threatened to veto that bill. Bizarrely, he also threatened to veto another bill (approved by an even broader bipartisan majority) that would make legal his illegal delay of the employer mandate.

So perhaps we should not be too surprised now that the New York Times reveals yet another delay the president approved at the behest of big business:

In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.

The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014…

[F]ederal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs…

A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: “We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person’s out-of-pocket costs. They asked for more time to comply.”…

Theodore M. Thompson, a vice president of the National Multiple Sclerosis Society, said: “The promise of out-of-pocket limits was one of the main reasons we supported health care reform. So we are disappointed that some plans will be allowed to have multiple out-of-pocket limits in 2014.”

It is a sign of Obamacare’s complexity that the Obama administration felt it needed to issue this delay. It is a further sign of the law’s complexity that this delay was announced in February, yet is only coming to light now.