Remote Area Medical’s Stan Brock, who spoke at the Cato Institute’s 2012 State Health Policy Summit, explains:

The culprit is state medical licensing laws. For more, read Cato adjunct scholar Shirley Svorny.

On May 11, the Department of Health & Human Services finalized rules requiring insurers to tell any of their customers who get premium rebates this summer that the windfall comes courtesy of Obamacare. Here’s the official required language: “This letter is to inform you that you will receive a rebate of a portion of your health insurance premiums. This rebate is required by the Affordable Care Act-the health reform law.”

Given that Obamacare is already increasing costs for most patients — insured or otherwise — I wonder who the lucky few will be who get a chance to read the government’s prose. Moreover, it’s a bit rich to create this “language mandate” when HHS Secretary Kathleen Sebelius had earlier advised insurance companies not to speak against Obamacare’s cost-increasing features. As the Competitive Enterprise Institute’s Hans Bader put it:

Obama’s HHS secretary sought to gag insurers that disclosed how Obamacare’s mandates are increasing the cost of health insurance, even though such speech is clearly protected by the First Amendment, telling them if they did so, they could be excluded from health insurance exchanges. Prior to that, the Obama administration attempted to gag insurers from disclosing how Obamacare harms Medicare Advantage participants, drawing criticism from First Amendment experts like UCLA law professor Eugene Volokh, the author of two First Amendment textbooks.

Beyond the unseemliness of it all, however, there’s also a constitutional problem: The government can’t require people to make politicized statements, whether that’s “Live Free or Die” on license plate or the labeling of consumer products where the labels aren’t justified on fraud-prevention or public health grounds. See some other examples and legal analysis in Bader’s post at CEI’s blog.

The bottom line is that just like the First Amendment stops the government from censoring speech, it stops it from forcing speech. And just like there’s no “health care is unique” exception to the Commerce Clause, there isn’t one to the First Amendment.

Here’s a poor, unsuccessful letter I sent to the editor of the Washington Post:

“GOP stalls on insurance marketplaces” [May 12] reports that “the conservative firm Leavitt Partners…is working with a number of states on their plans” to create the government bureaucracies that the new health care law calls insurance “exchanges.”

The article should have informed readers that this “conservative firm” (whatever that means) is a for-profit government contractor that makes money by helping states create those exchanges, and is acting against the advice of the nation’s leading conservative think tank. The Heritage Foundation counsels states not to create exchanges, and to send all related funds back to Washington.

Finally, the article claims states can avoid a “federal takeover” by creating an exchange. On the contrary, the law requires state-run exchanges to obey all federal edicts, just as a federal exchange would. The federal takeover has already happened. States that create their own exchanges merely pay for the privilege of losing their sovereignty.

Here’s a poor, unsuccessful letter I sent to the editor of Politico:

An item in Politico’s health care newsletter Pulse [“Today: Christie Vetoes Exchange Or Else,” May 10] told readers that, because I oppose ObamaCare, I am a “health reform foe.”

Is that what Politico gleans from my conversations with its reporters about the need for health care reform, and how I would go about it? From the hundreds of articles and opeds and speeches and blog posts in which I detail my preferred reforms? And from the book I coauthored about how to reform health care? Is it Politico’s editorial policy that one cannot support health reform without supporting ObamaCare?

Other news organizations, moreover, avoid describing ObamaCare as “reform,” a term that connotes improvement. Is it Politico’s editorial policy to convey to readers that ObamaCare is an improvement?

Here’s a poor, unsuccessful letter I sent to the editor of the New York Times:

When Gov. Andrew Cuomo (D) created a new ObamaCare “exchange” by executive order, it was indeed “A Deft Health Care Move” [Apr. 18].

Really, what was he supposed to do? Let legislators decide whether to commit taxpayers to such an expense? (They had declined.) Sit back and let the federal government pay for its own Exchange? (That was the alternative.) Block a $3,000-per-worker tax on employers? (Had Cuomo done nothing, New York employers would have been exempt from ObamaCare’s “employer mandate.”)

Cuomo brilliantly and single-handedly volunteered New Yorkers to pay for a new government bureaucracy and burdened New York employers with a new, job-killing tax. Who needs a legislature!

Here’s a poor, unsuccessful letter I sent to the editor of the Washington Post:

A recent article [“Could the health-care law work without the individual mandate?”, Mar. 28, A8] claims the IRS “will be barred from using … collection tools such as placing liens or threatening incarceration” to enforce compliance with the requirement that Americans obtain health insurance. Not so.

Suppose the IRS assesses me a $1,000 penalty for failing to obtain health insurance. It is true that the law prohibits the IRS from using liens or incarceration to collect that $1,000. But, money being fungible, the IRS may simply deem my first $1,000 of income-tax withholding to be payment of that penalty. As a result, I would owe an additional $1,000 in income tax at the end of the year, and the IRS could come after me with every tool at its disposal, including liens and incarceration.

Here’s a poor, unsuccessful letter I sent to the editor of the Washington Post:

“Health-care provision at center of Supreme Court debate was a Republican idea” [Mar. 27, A7] describes the health care law Mitt Romney signed while governor of Massachusetts as comprised of “free-market ideas.” Really?

RomneyCare’s individual mandate, now mirrored in ObamaCare, uses the power of the state to compel people to health insurance. What could be more un-free than that?