Freedom Line Blog

A new report says that the number of Americans who are ‘underinsured’ is 31 million people – double the figure from 2003.

Being underinsured means that a person has access to health insurance, but doesn’t use it to get healthy because the cost is too high.

ObamaCare – with the popularity of its high deductible insurance plans – may make the problem worse.

“The steady growth in the proliferation and size of deductibles threatens to increase underinsurance in the years ahead,” says the Commonwealth Fund report.

“People who have high deductibles do tend to skimp on healthcare,” Sara Collins, the study’s lead author, said to reporters.

That’s because a trip to the doctor’s office can generate thousands of dollars in out-of-pocket expenses before the insurance company contributes a penny.

The Obama administration has claimed a lot of credit for lowering the uninsured population, but has been unsurprisingly mum about the uptick in the number of underinsured Americans. If this trend continues, millions of people will be forced to pay for a financial product they cannot afford to use, but dare not risk going without since the IRS has the power to penalize.

That sounds like a policy opportunity conservatives would do well to exploit.

H/T: The Hill

In this week’s Freedom Minute, CFIF’s Renee Giachino demands accountability for the apparent fraud that took place enabling Members of Congress and their staff to circumvent clear rules under ObamaCare in order to keep their taxpayer-subsidized health insurance. 

A group of 18 House Democrats sent a letter recently to Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) requesting “timely passage” of a bill to repeal perhaps the most unpopular ObamaCare tax.

The medical device tax levies a 2.3 percent fee on medical devices, and is credited with causing increased prices and a decline in jobs within the manufacturing industry. Much of the Democratic support for repeal comes from members representing states with large device making companies in Minnesota and Indiana.

In a divided Congress, repealing the medical device tax may be the best way demonstrate bipartisan opposition to ObamaCare. Last year, 79 Senators voted to repeal this tax though then Majority Leader Harry Reid (D-NV) refused to bring it to a floor vote. With Republicans in control of the chamber, a vote is likely to occur.

Even if President Barack Obama vetoes the measure – which the White House has promised he will do unless Congress imposes another tax to offset the revenue loss – the mounting pressure to get rid of the medical device tax indicates that there are political victories to be had, if congressional leaders will push for them.

Add Hawaii to the growing list of states that can’t afford to continue funding their financially unsustainable ObamaCare exchange.

“The state’s exchange is drowning in their own debt and is set to shut down by September 30,” writes Kristina Ribali of the Foundation for Government Accountability. “Administrators had been hoping to get a funding boost from state lawmakers, during their current legislative session, but that will not happen.”

Hawaii’s death spiral became clear in January when the federal government notified the state that it was out of compliance with ObamaCare’s performance benchmarks. By this year state exchanges have to prove their long term financial viability, and their IT systems must be integrated with the Medicaid database. The latter requirement ensures that applicants are correctly channeled to the appropriate government assistance program.

Hawaii – like Oregon, Nevada, New Mexico, Colorado, Minnesota, Maryland, Massachusetts and Vermont – isn’t generating enough revenue in enrollment fees to make its exchange solvent. Its failure to integrate IT systems is likely the final blow before the state hands over its exchange function to Healthcare.gov, the federal counterpart.

Like the other states just mentioned, Hawaii’s ObamaCare exchange failure has been expensive: $204.3 million.

And counting…

Health insurance exchanges are a great idea – as long as the government isn’t the one running them.

“In a private exchange, an employer can make a defined contribution to a tax-free group plan chosen by the worker,” explains Robert Moffit. “If the worker purchases a less expensive plan, the worker can keep the difference in savings. A worker who wants a more expensive plan can top off the employer’s contribution with her own money.

“In a well-run private exchange, self-insured employers can offer greater flexibility in benefit design, allowing workers and their families choice among a variety of health plans offered by multiple carriers,” Moffit continues. “With cost calculators, plan and provider performance ratings, and easily accessible network and formulary information, workers are suddenly empowered to make well-informed health-care decisions. In the style of 401(k) pensions, the private exchange could emerge as the transformative platform for a revolution in health-care financing.”

Interestingly, enrollment in private health insurance exchanges is now at 6 million – double what it was in 2014. That’s almost equal to the 7+ million currently enrolled through Healthcare.gov, the federal ObamaCare exchange.

One way to move health insurance reform away from the top-down, government-run model of ObamaCare would be to grant vouchers to individuals and families that don’t get coverage from an employer. Government could then go back to what it does best – giving out money – while letting the private sector do its job – delivering services at an affordable price while still making a profit.

Best of all: Almost 20 fewer government bureaucracies.

The reason 35 states chose not to build a local ObamaCare exchange – even though the federal government made billions of dollars available to do so – is pretty simple: After an initial burst of funding the a state must foot the bill to maintain it.

That’s turning out to be a very costly proposition.

Consider Oregon.

“The case of Oregon is the most extreme,” explains an editorial in the Washington Examiner. “After spending $200 million to develop its own health insurance exchange, the Beaver State was forced to abandon it altogether because of pervasive and intractable technical problems.”

It gets worse.

“Tiny Vermont spent roughly $4,000 for every uninsured Vermonter to develop its exchange – more than enough to buy a pre-ObamaCare policy for everyone for an entire year,” says the editorial. “And yet after spending so much, the Green Mountain State may soon follow Oregon’s lead in abandoning its creation. Minnesota faces a similar situation.”

Recall that ObamaCare’s upfront establishment grant money was designed to make it seem like the controversial health law didn’t add to the federal deficit by enticing states to take on the legacy costs of operating the exchanges. With Healthcare.gov becoming the de facto nationwide ObamaCare exchange, that gamble has backfired, but not before wasting lots of taxpayer money.

At least 37 states have received a total of $4.8 billion to implement ObamaCare, but under the terms of the “establishment grants” those monies cannot be used to pay for overhead costs like rent, software maintenance, staffing and utilities.

That hasn’t stopped some states from trying, apparently.

“We have concerns that, without more detailed guidance from [the Centers for Medicare and Medicaid], [State-based ObamaCare exchanges] might have used, and might continue to use, establishment grant funds for operating expenses after January 1, 2015, contrary to law,” writes the Inspector General at the Health and Human Services Department.

“In media reports and during our review of [states’] budget information, we have observed that some [states] face uncertain operating revenues in 2015 and future years. Because operating revenues are uncertain, there is a risk that [states] might use establishment grant funds to cover operational expenses,” warns the IG’s letter.

The IG points to evidence that the Rhode Island exchange does not have a dedicated funding source, and the Washington exchange is short $125 million unless the state legislature steps in.

In other words, ObamaCare gave seed money to start expensive new state agencies that are now supposed to be self-sustaining. At least two are not, and the tone of the IG’s letter implies that many more are suspect.

If an enterprising conservative committee chairman wants to protect taxpayers while exposing one of the failures of ObamaCare, following up on the IG’s warning letter with a detailed investigation would be a good strategy.

H/T: The Hill

Recent statements by likely GOP presidential candidates indicate the answer may be no.

“Republican governors across the country, including several conservatives, couldn’t resist the siren song of federal dollars and chose to expand Medicaid under ObamaCare,” writes Stephen F. Hayes at The Weekly Standard. “The federal government promises to fully fund Medicaid expansion for three years, after which the federal dollars are phased out and states will be responsible for paying for the expanded program themselves.”

Those governors include John Kasich of Ohio and Chris Christie of New Jersey. Both argue they made the best of a bad policy situation. Former governor Mike Huckabee of Arkansas could also be added to the mix, since he has recently distanced himself from Wisconsin Congressman Paul Ryan’s entitlement reform package ahead of an anticipated presidential bid.

After three years of party unity – broadly speaking – on entitlement reform, Republican leaders seem to be charting different paths on how to tackle the issue. This can and should be a healthy exercise in deliberation and persuasion, precisely the kind of policy-centric debate so necessary in the primaries.

That is, if the conversation stays on topic. Kasich, for example, has already shown a willingness to demonize critics instead of responding with a better argument. To wit, when health policy expert Avik Roy asked Kasich how he could be against ObamaCare’s “top-down government” but support Medicaid’s version of the same, Kasich retorted, “Maybe you think we should put them [the poor] in prison. I don’t.”

Hillary Clinton’s attack machine couldn’t have said it better. For the good of the conservative movement, Kasich and the rest of the presumptive GOP presidential field should.

Sometime in June, the U.S. Supreme Court is expected to publish its opinion deciding whether the Obama administration acted outside the law in extending federal subsidies to citizens in states without a local ObamaCare exchange.

If the Court’s ruling adheres to the rule of law, the subsidies will be disallowed. Predictably, this is making some Republicans nervous that Americans getting the ObamaCare the Democrats passed will blame the GOP.

And so, there are a growing number of proposals to overrule the Court, at least until 2017 when (hopefully) a Republican president will be in office.

The latest plan in this line of thinking was unveiled Tuesday by U.S. Senator Ron Johnson (R-WI). “Johnson’s plan would allow people to keep their ObamaCare plans and their subsidies until August 2017,” reports The Hill. “The bill would also repeal ObamaCare’s mandates for individuals and employers to provide insurance…”

Of the proposals currently available, Johnson’s is the only one that makes no change to ObamaCare as it currently is. All it does is ensure the program lasts until about eight months into the next president’s first year in office.

The question is: What’s the point? If Johnson’s bill were to become law, it would put large numbers of Republicans on record as saying that despite the plain meaning of the statute, ObamaCare’s subsidy scheme is simply too important to be governed by normal legal rules. If that’s true, then why not make things easier and introduce a bill that just amends the disputed section and grant subsidies to everyone?

If Senator Johnson and other Republicans are fearful of voter backlash, then he and others should propose specific policy alternatives. Overruling the Supreme Court for making the correct legal decision is not justified by political calculations of what might happen at the ballot box.

Voters deserve statesmen, not politicians that hedge their bets. If Senator Johnson wants to be reelected next year, he needs to earn the privilege by either embracing ObamaCare for the long-term or putting forward a specific alternative.

Nearly every American that received an ObamaCare subsidy to help pay for health insurance last year got the wrong amount.

“Only 4 percent of the people who signed up for ObamaCare got the correct subsidy, so a whopping 96 percent will see their tax bill adjusted, some up and others down,” writes Betsy McCaughey. “Who would design a system that’s right only 4 percent of the time?”

The main reason for the discrepancy is that a person must estimate – i.e. guess – their entire taxable income for the next year in order to find out how much of a subsidy they qualify for under ObamaCare during enrollment season. A raise or switch to a higher paying job could be zeroed out because the government gets to “clawback” the difference. Losing a job means a fatter refund.

You can see which direction ObamaCare’s incentives point to, which provides a partial answer to McCaughey’s rhetorical question – people who penalize moving up the income ladder.

If you are one of the estimated 800,000 Americans who purchased an ObamaCare-compliant health insurance policy for the 2014 enrollment year through Healthcare.gov – the federal exchange portal – and received the wrong tax reporting form, you now have until October 15 to file your taxes.

The Treasury Department announcement came last Friday, less than two weeks before the traditional tax filing deadline.

Credit where it’s due – this is the right call by the Obama Administration since it was the government – not taxpayers – that fouled up the process by mailing error-laden reporting forms. The six month extension relieves the pressure on taxpayers and their accountants and hopefully gives the bureaucracy enough time to fix the problem.

Nevertheless, like all of the other unilateral delays and waivers granted under ObamaCare, this development is yet another indication that the federal government bit off more than it can chew and the number one casualty is the rule of law.

Daniel Payne at The Federalist has a must-read article explaining the perverse and punitive feature of ObamaCare that allows the federal government to “clawback” subsidy amounts from eligible recipients.

“If you’re flat broke at the beginning of the year and accept tax credits from ObamaCare for several months, then find a high-paying job with health insurance halfway through the year and make enough money to put yourself over the subsidy threshold, you’ll owe back every penny of those subsidies you received come tax season, even though you had no money when you received them,” writes Payne.

ObamaCare’s critics have warned that the law would discourage people from getting better paying jobs for fear of losing their health insurance subsidy. In practice, it looks like the penalty on work could be even worse.

Today, Reuters ran the following headline claiming that Republican governors opposed to ObamaCare are really just a bunch of hypocrites: “Exclusive: Republican White House hopefuls attack Obamacare but take money”.

The evidence offered is a combined $352 million in federal grants that GOP governors Rick Perry (TX), Scott Walker (WI), Bobby Jindal (LA), and Chris Christie (NJ) applied for and won under the terms of ObamaCare. Lest any reader miss the theme of the article, the author writes, “Aides [to each governor] told Reuters they saw no contradiction in applying for these grants while criticizing the law as a whole.”

The aides – and by extension, the governors – are absolutely correct. According to the Reuters report, many of the grant programs predate the passage of ObamaCare, and the ones that originated with the controversial health care law are not connected to either the excessively expensive health insurance exchanges or the Medicaid expansion – the two policy devices loathed by fiscal conservatives. As a matter of policy then, there is nothing inconsistent about wanting to repeal a law to get rid of its bad elements while supporting parts that have no connection to them.

As if to walk back from its misleading headline, the Reuters piece says that “It’s not clear whether the Republican governors now considering running for the White House would protect these programs if they won the November 2016 presidential election.” Except that it is clear. So far, none of these governors have indicated that in repealing ObamaCare they would refuse to reinstate the non-controversial grant programs. Therefore, it’s reasonable to assume that these programs are safe.

Attention-grabbing headlines are necessary in the news business, but only if they’re true. The next time Reuters wants to ding GOP politicians for hypocrisy, it needs to bring much better evidence than this.

The Obama administration got a rare piece of good news today when the U.S. Supreme Court declined to overturn a Ninth Circuit Court of Appeals decision upholding part of ObamaCare.

The case, Coons v. Lew, is an Arizona-based challenge to the Independent Payment Advisory Board (IPAB), the 15-member group of experts empowered to reduce Medicare spending below a certain threshold.

In declining the plaintiffs’ appeal, the Supremes did not in any way indicate that this case is without merit. Rather, it may have been filed too early. Courts are typically loathe to strike down parts of laws that have yet to go into effect. IPAB won’t be making any decisions until 2019 at the earliest.

As usual, the issue is whether IPAB is constitutional. “Its decisions cannot be overridden by Congress without a super-majority and cannot be challenged in court,” explains a report in Politico. If that sounds like near monarchial power for an unelected bunch of experts, well, this is the Obama administration after all.

For now, IPAB is a dormant legal issue. Time will tell if it becomes a political rallying cry in next year’s presidential election.

If you didn’t have health insurance last year, could afford it (according to ObamaCare), and don’t have a waiver from the individual or employer mandate, you will be getting a notice from the IRS this year that you owe Uncle Sam some money.

Apparently, this will be a surprise to a lot of people.

“A Kaiser Family Foundation poll released Thursday found that while slightly more than half of respondents were aware the penalty kicks in this year, one in five think it goes into effect next year, roughly one in six say they don’t know when it goes into effect, and one in 10 believe it was rolled out last year,” reports the Washington Examiner.

Look for ObamaCare’s unpopularity to increase even more after Tax Day.

In an interview with CFIF, Sally Pipes, President, CEO and Taube Fellow in Health Care Studies at the Pacific Research Institute, discusses oral arguments before the U.S. Supreme Court in the King v. Burwell case, the damaging effects of ObamaCare, and what state lawmakers and members of Congress should be doing now to prepare for a potential ruling that derails the Affordable Care Act.

Listen to the interview here.

Daniel Hannan, a British conservative serving in the European Parliament, warns Americans about the danger of propping up ObamaCare long enough for it to get entrenched in everyday life.

“ObamaCare isn’t a precise copy of the British health system. But there is one parallel on which its exponents are relying, namely the conflation of their healthcare model with the people who work in it,” writes Hannan. “The chairman of the body in charge of overseeing care quality in Britain recently put his finger on the problem: ‘The NHS became too powerful to criticize. When things were going wrong, people didn’t say anything. If you criticized the NHS – the attitude was how dare you?’”

Something similar seems to be happening now. Some states are getting ready to install ObamaCare exchanges if the Supreme Court strikes down the IRS subsidies as unlawfully distributed to people using the federal Healthcare.gov website.

Others are suggesting the creation of an “off-ramp” from ObamaCare that would keep the subsidies flowing until the 2016 presidential election, but would also extend the health law’s life span.

These kinds of half-measures do nothing to help move health reform in a more sustainable, market-oriented direction. All they do is put a bipartisan face on ObamaCare, albeit in an altered form.

Part of what makes repealing ObamaCare a realistic option is the steadfast resistance from state and federal Republicans in implementing it. If even a significant minority of GOP leaders start to go along with saving ObamaCare – in whatever form – then the United States runs the risk that Hannan in Britain knows all too well.

Socialized medicine will be here to stay.

If the U.S. Supreme Court (correctly) interprets the health care law as disallowing insurance subsidies for citizens using the federal Healthcare.gov website, some states are preparing to fast-track the process for creating their own ObamaCare exchanges.

That process won’t be easy.

“The first step would be enactment of a law authorizing a state agency, nonprofit or public-private entity to run the exchange. Next, the state would have to build or acquire a website to enroll residents, take over contracts with insurance carriers, develop a consumer assistance program and create a bureaucracy to operate the exchange,” says a summary published by the Pew Charitable Trusts.

Nor will it be cheap. States that opted to build their own exchanges had almost three years to get them up-and-running, and there were still a number of expensive failures. Trying to accelerate the process into a matter of months will only invite more wasted taxpayer money.

States that refused to sink money into an ObamaCare exchange were right to resist adding another layer to their health care bureaucracies. Citizens don’t need another government program with costly administrators. We need a simplified system of health care delivery that frees up more money for treatment and prevention.

A letter from House Ways and Means Chairman Paul Ryan (R-WI) demands an explanation from the Treasury Department on why it allowed $3 billion in payments to ObamaCare insurance companies that Congress never approved.

In a well-documented piece, Philip Klein gives a disturbing summary of the Obama administration deliberately refusing to follow the law.

“At issue are payments to insurers known as cost-sharing subsidies,” writes Klein. “These payments come about because President Obama’s healthcare law forces insurers to limit out-of-pocket costs for certain low income individuals by capping consumer expenses, such as deductibles and co-payments, in insurance plans. In exchange for capping these charges, insurers are supposed to receive compensation.”

Here’s the rub.

“What’s tricky is that Congress never authorized any money to make such payments to insurers in its annual appropriations, but the Department of Health and Human Services, with the cooperation of the U.S. Treasury, made them anyway,” says Klein.

As proof, Klein cites a $4 billion funding request for the cost-sharing subsidies program in 2014 that was not fulfilled by Congress. It’s now 2015, the bills are coming due, and the Obama administration effectively said, “Never mind.”

Whether the domain is immigration or ObamaCare, the default setting for this administration seems to be that if it can’t get what it wants the legal way, it’s just as good to go around the law.

First Uncle Bear, now Uncle Sam.

“The Obama administration says it sent about 800,000 HealthCare.gov customers the wrong tax information, and officials are asking those consumers to delay filing their 2014 taxes,” reports CNBC.

The massive blunder comes on the heels of a similar admission by California officials that the state sent out approximately 100,000 error-laden tax forms to residents using the state’s ObamaCare exchange, Covered California.

No timeline was apparent on when revised forms would be sent out, or whether early tax filers would be penalized by the Internal Revenue Service for submitting unknowingly false information.

Another item in the CNBC report may foreshadow the next move. Due to concerns that some people will be angered for being penalized for not buying insurance to comply with ObamaCare’s coverage mandate, the Obama administration is creating another sign-up extension.

Perhaps the IRS will get similar instructions from on high and bump back the filing deadline.

If so, expect to hear the millions of non-ObamaCare customers clamor, “Me too!”