Dennis Smith directed the Medicaid program for President George W. Bush and was a health care analyst at the Heritage Foundation before becoming Wisconsin Gov. Scott Walker's (R) secretary of health. The following excerpts are from a [subscription only] article at WisPolitics.com:
In his first extensive interview since a U.S. Supreme Court ruling largely upheld the federal law, the Department of Health Services chief said fed deadlines are likely to change and that the lack of guidance on setting up the exchanges makes any state-run exchange "a fantasy."...
Part of the reason why Smith says Wisconsin hasn't moved forward with a health exchange plan is because he believes the deadlines will be pushed back.
"We have no other plan that we are taking because we think the reality is the federal government cannot meet its deadlines for implementing PPACA," Smith said. "No one knows what a federal exchange looks like. The two major components that an exchange is supposed to do, which is determine eligibility and to complete the business transaction to pay premiums to health care plans that millions of Americans are supposed to pick, nobody knows what those look like. The administration has failed to release a credible business plan where objective observers could conclude that they're going to pull this off."
Smith also said that none of the states currently setting up exchanges would likely meet federal regulations and that there's "no such thing as a state-run exchange."...
"They were going to be asking for the resumes for the people who sit on the board of overseeing an exchange," Smith said. "They were micromanaging the governance structure. They didn't have to do that, they chose to do that. But that's slowing the process and the decision making."
The secretary especially pointed to questions on who will be eligible for the exchanges and the appropriate level of tax credits for participants. He claimed the rules on determining accuracy of tax credit payments were too "nonchalant," and could result in the IRS having to recover thousands of dollars because of potential inaccuracies.
"It's not that they don't have answers because they're withholding it from us, it's that they don't have answers because they don't have answers," Smith said. "These are critical policy issues, critical technical issues. Again, what are you building if you don't know who's eligible? What are you building if you don't know what the flow is out of the treasury to the health plan?"
..."They have a mess on their hands," Smith said... "You have to fundamentally say, 'No, that just isn't working, we have to go back to the drawing board.'
"And that is not being partisan in the slightest. That is facing reality."
And that's from a guy who continues to support the concept of a government-created health insurance exchange.
I'm a bit late to this party, but Senate Minority Leader Mitch McConnell (R) was of course right to tell Fox News' Chris Wallace last weekend that the federal government should not pursue universal coverage:
Wallace: In your replacement [for ObamaCare], how would you provide universal coverage?
McConnell: Well, first let me say the single best thing we can do for the American health care system is to get rid of ObamaCare...
Wallace: But if I may sir, you talk about "repeal and replace." How would you provide universal coverage?
McConnell: ...We need to go step by step to replace it with more modest reforms...that would deal with the principal issue, which is cost...
Wallace: ...What specifically are you going to do to provide universal coverage to the 30 million people who are uninsured?
McConnell: That is not the issue. The question is, how can you go step by step to improve the American health care system...
Wallace: ...If you repeal ObamaCare, how would you protect those people with pre-existing conditions?
McConnell: ...That's the kind of thing that ought to be dealt with at the state level...
McConnell would have seemed less evasive and could have stopped Wallace in his tracks had he said, "We will not pursue universal coverage because that causes more people--not fewer--to fall through the cracks in our health care sector."
Michael Cannon, director of health-care policy at the libertarian Cato Institute, formed the “Anti-Universal Coverage Club,” whose members “reject the idea that government should ensure that all individuals have health insurance.” This attitude is now the norm within the Republican Party, even if it is rarely acknowledged so starkly.
Dear Republicans: You're welcome.
With all eyes on the Supreme Court, whose ruling on ObamaCare's individual mandate could come as early as today, almost no one noticed that last month the IRS imposed an illegal tax on employers of up to $3,000 per worker.
Jonathan Adler and I explain in today's USA Today that this illegal tax is the indirect but very real result of the IRS offering ObamaCare's tax credits and subsidies in health insurance "exchanges" created by the federal government, even though ObamaCare restricts those entitlements -- explicitly, laboriously, and unambiguously -- to Exchanges established by states.
That illegal action has the effect of imposing ObamaCare's $2,000-$3,000 per worker tax (i.e., the "employer mandate") on employers who otherwise would be exempt (i.e., employers in states that do not create an Exchange). Perhaps President Obama thought "taxation without representation" would be a winning campaign slogan.
If the Supreme Court fails to strike down ObamaCare's employer mandate, Exchanges, and health insurance tax credits and subsidies, this thoroughly unconstitutional IRS rule will begin illegally taxing employers in 2014.
Reps. Scott DesJarlais (R-TN) and Phil Roe (R-TN) have introduced a resolution under the Congressional Review Act that would block the rule. Barring that, expect more angry employers to haul ObamaCare into federal court.
Adler discusses the IRS rule here:
It is becoming apparent even to members of the party that gave us ObamaCare that helping to implement the law by establishing a health insurance Exchange is a bad deal for states. Yesterday, NewHampshireWatchdog.org reported:
Governor Lynch blocks Health Insurance Exchange for NH
(CONCORD) Governor John Lynch [D] this morning signed legislation blocking implementation of a health insurance exchange in New Hampshire. The Obama Administration has been urging states to set up exchanges under the Patient Protection and Affordable Care Act, known as ObamaCare.
Lynch has supported setting up a New Hampshire exchange, including the proposal in his State of the State address in February. Senate legislation setting up an exchange, SB 163, won Committee approval in January before stalling on the Senate floor. Opponents argued that a state-run exchange would put New Hampshire taxpayers on the hook for the costs of administering much of the federal health care law, while giving the state little flexibility from federal mandates.
Representative Andrew Manuse (R-Derry) introduced HB 1297 to prevent state officials from setting up an exchange without legislative approval. Josiah Bartlett Center President Charlie Arlinghaus led the charge for the bill, arguing that if federal officials wanted to set up a New Hampshire insurance exchange, they could pay for it themselves. (The Josiah Bartlett Center for Public Policy is the parent organization of New Hampshire Watchdog.)
Under the new law, state health and insurance officials may share information with their federal counterparts but may not take any steps to implement a state-controlled insurance marketplace.
Governor Lynch’s office did not respond to requests for comment on HB 1297.
It does not speak well of ObamaCare that Democrats are heading for the exits.
In this video, I explain why all states should flatly refuse to create an ObamaCare Exchange:
For the true ObamaCare junkies, I include my oral and written remarks to New Hampshire legislators back in February about the dangers of creating an ObamaCare Exchange (non-junkies should just stick to the above video):
And let's not forget Jonathan Adler's latest take:
Remember that guy?
Well today, the Wall Street Journal reprints a series of emails showing how his administration colluded with drug-company lobbyists to pass ObamaCare. Never mind the nonsense about Big Pharma making an $80 billion "contribution" to pass the law. An accompanying Wall Street Journal editorial explains that Big Pharma "understood that a new entitlement could be a windfall as taxpayers bought more of their products."
The money quote from these emails comes from Pfizer lobbyist/Republican/former George W. Bush appointee Anthony Principi. Even though the drug companies were donating to all the right politicians and pledging to spend hundreds of millions of dollars on pro-ObamaCare advertising campaigns and grassroots lobbying, President Obama still accused unnamed "special interests" of trying to stop ObamaCare in order to preserve "a system that worked for the insurance and the drug companies." Principi was indignant:
We're trying to kill it? I guess we didn't give enough in contributions and media ads supporting hcr. Perhaps no amount would suffice.
The nerve. I smell a campaign slogan. "Barack Obama: a Politician Who Cannot Stay Bought."
The Journal adds:
[Former Energy and Commerce Chairman Henry] Waxman [D-CA] recently put out a rebuttal memo dismissing these email revelations as routine, "exactly what Presidents have always done to enact major legislation." Which is precisely the point—the normality is the scandal.
And which critics have argued from the beginning. As I wrote more than two years ago, ObamaCare is corruption:
Each new power ObamaCare creates would be targeted by special interests looking for special favors, and held for ransom by politicians seeking a slice of the pie.
ObamaCare would guarantee that crucial decisions affecting your medical care would be made by the same people, through the same process that created the Cornhusker Kickback, for as far as the eye can see.
When ObamaCare supporters, like Kaiser Family Foundation president Drew Altman, claim that “voters are rejecting the process more than the substance” of the legislation, they’re missing the point.
When government grows, corruption grows. When voters reject these corrupt side deals, they are rejecting the substance of ObamaCare.
Fortunately, voters so detest ObamaCare that there's a real chance to wipe it from the books. This video explains how state officials can strike a blow against ObamaCare/corruption: