Freedom Line Blog

The latest ObamaCare delay guarantees that the law’s arbitrary implementation will be a huge issue in the 2016 presidential campaign.

“The change was included in last week’s announcement that the government would let people keep otherwise out-of-compliance health plans for another two years,” reports Fox News. “Buried in the official memo was a line giving people whose policies were canceled a ‘hardship exemption’ through October 2016.”

That means no who qualifies for this exemption has to pay a fine under the individual mandate until President Barack Obama is leaving office.

Talk about forcing someone else to do make all the hard decisions. Because of the current president’s refusal to shoulder the burdens of implementing his own law it seems like a certainty that the campaign to succeed him will be dominated by questions he can’t bear to answer now.

In short, get used to ObamaCare being a flashpoint in our politics for a long time to come.

And it just so happens to be the most crucial.

With only 4.2 million of the original 7 million Obamacare exchange enrollees confirmed, officials at the Department of Health and Human Services were asked yesterday whether they would extend the March 31 deadline.

“We have no plans to extend the open enrollment period,” responded an HHS official, according to the Weekly Standard. “In fact, we don’t actually have the statutory authority to extend the open enrollment period in 2014.” (Emphasis added)

Of course, none of the controversial Obamacare delays are rooted in the law’s statutory text. When pressed for an explanation of how the enrollment deadline is different from the extra-legal delays of the individual mandate, employer mandate, small business exchange, Cadillac tax and thirty other extensions, the HHS spokespeople had no credible response.

The question remains, though, Why not extend the enrollment period in order to get more sign-ups? My guess is that broadening the enrollment timeline would quickly destroy the Obama administration’s ability ever to impose another deadline. As we saw last week with the second yearlong delay allowing non-compliant individual plans to continue, once an exception is made the firmness needed to impose a new drop-dead-date disintegrates. Rules become subject to whim not reason.

And make no mistake, if the Obama administration folds on this deadline the whole logic of Obamacare crashes and burns. If there is no penalty for non-enrollment then there is an incentive for each person to wait until he or she gets sick before buying health insurance. To participate on an Obamacare exchange an insurance company must accept whoever wants to buy a plan. Insuring sick people at the point of sale is no longer insurance since every purchaser needs the service immediately. For Obamacare to work as designed, however, the law and its insurance company partners need a majority of people paying for benefits only a minority will access.

That’s the real reason the Obama administration won’t delay the March 31 enrollment deadline. It can’t afford to.

The Hill is reporting that the Obama administration will extend for an additional year the ability of insurance companies to offer consumers plans that do not comply with Obamacare requirements. The current one-year extension is set to expire in October of this year, about a month before the 2014 midterm elections.

It is universally acknowledged that the reason for the extended extension is so that Democrats up for reelection can avoid having to explain to voters why the cheaper insurance plans they like are being canceled and replaced with more expensive options.

As one insurance industry source told The Hill, “I don’t see how they could have a bunch of these [cancellation] announcements going out in September, [n]ot when they’re trying to defend the Senate and keep their losses at a minimum in the House. This is not something to have out there right before the election.”

When the legality of a person’s health insurance depends on the timing of a political campaign, it’s obvious that health care has become politicized.

But while subjecting millions of Americans’ insurance plans to the expediency of a political party is certainly bad, the fact that no year seems to be a good year to fully implement Obamacare offers something like a silver lining. The whole point of terminating non-compliant insurance plans between October 2013 and January 2014 was to inflict maximum damage a year before voters went to the polls. The thinking was that other issues would eventually overshadow the anger and price spikes, allowing Democrats to avoid the consequences of entrenching their favorite policy.

Going forward, it’s hard to see how the Obama administration won’t become addicted to its own avoidance behavior. Though barred from seeking a third term in office, Obama will be under enormous pressure from Hillary Clinton and other Democratic presidential candidates, as well as members of Congress, to continue delaying enforcement until after the 2016 elections. After all, letting Obamacare go into effect will provide Republicans with a perfect campaign issue. Why not keep it off the table?

However, if that’s the tack they take it paves the way for another GOP line of attack – If Obamacare is too horrid to live with before an election, it certainly can’t be tolerated after.

After years of politicizing medicine by not enforcing its own law, the Obama administration may succeed in convincing Americans that Obamacare isn’t worth the pain it will inflict.

Up to 38% of people who qualify for Obamacare exchange subsidies may have to pay some or all of the money back to the IRS. That’s because the amount of subsidy dispensed is based on a sliding scale. As income rises, the amount of subsidy decreases. In practice, many people who currently qualify for a subsidy could wind up paying back the amount if they earn just a little bit more in income.

“At biggest risk are people who annual household income put them near the thresholds where the Obamacare subsidies make steep declines,” explains AEI expert Scott Gottlieb. “These cliffs are steepest for those people who earn 150% of the federal poverty level (family of four earning $35,000 in annual household income); 250% (a family of four earning about $55,000 annually); and 400% (a family of four earning about $95,000 annually).”

The upshot of this is that people may become much more sensitive to family budgeting since their financial stability depends on which side of the subsidy wall they fall. The downside of course is that we’re likely to start seeing people decline job promotions and salary hikes to avoid becoming a net loser at tax time.

As I’ve noted before, Obamacare’s War on Work is just beginning.

Pay now or pay later.

That’s the choice facing millions of Americans required by Obamacare’s individual mandate to select a health insurance plan through a state or federal exchange.

Insurance companies like Aetna, Humana and Blue Cross and Blue Shield who are participating on various exchanges report that the most popular choices among consumers are middle-of-the-road “silver” plans that typically offer moderate premiums but high deductibles and coinsurance.

Deductibles require policyholders to pay all of the cost for medical care up to  a certain threshold before the insurance company assumes responsibility, while coinsurance commits the policyholder to paying a certain percentage for the cost of medication. (Co-pays, on the other hand, are capped at a flat amount.)

The increased costs are likely to reduce the number of doctor and hospital visits as consumers become choosier. “When deductibles and co-payments are high, patients tend to think twice about their health care purchases, making them more likely to shop around for the best deal,” says health policy expert Bruce Japsen.

Indeed, basic economic theory teaches that knowing the price of something impacts a person’s behavior significantly. But while this may help people who would otherwise overuse health care to scale back, it can – and most likely will – have the effect of convincing people to underuse necessary treatment options for fear of the cost. Thus, we could end up with more people covered by health insurance but a more unhealthful population.

One of the key policy battles on the horizon is how to harness this new transparency in health care prices. Liberals will likely want to subsidize health care until they can socialize the entire industry. Conservatives will be predisposed to favor a market-based solution. But simply repealing Obamacare and its disastrous tax on medical devices, among others, and saying “let the market figure it out” won’t be enough – especially in a campaign context.

Some conservatives may favor working within the system to incent both consumers and health care companies to better align need and cost. Others may prefer to explore deregulating parts of the industry, such as allowing physician assistants and qualified nurses to do more of the work of a doctor while still under supervision (perhaps remotely via technology). These and other ideas need to be deliberated on intensely now so that conservatives aren’t caught off-guard when the electorate is ready for an Obamacare alternative. If not, we’ll all pay dearly for lacking a consensus at the moment we need it most.

A new report by the non-partisan Congressional Budget Office predicts the Affordable Care Act (i.e. Obamacare) will cause up to 2 million lower-income workers to leave the labor force over the next decade because they will make more in government benefits than as a private employee.

“CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor – given the new taxes and other incentives they will face and the financial benefits some will receive,” the agency says in Appendix C, Labor Market Effects of the Affordable Care Act: Updated Estimates (pdf).

The incentive to drop out of the workforce is one’s eligibility for a government subsidy to help pay for an insurance plan bought through an Obamacare exchange. Since eligibility for a subsidy phases out as a person’s income rises, people who will receive subsidies will have to factor in whether to take a job that makes more money, but will likely reduce or eliminate eligibility. In this scenario, taking the job may actually result in a net loss of income as the person must now pay for the full cost of health insurance.

The disincentive to work also applies to those hanging between Medicaid and Obamacare subsidies. Eligibility for Medicaid means the cost to the beneficiary is nothing (at least not directly). In this scenario, qualifying for a subsidy increases one’s out-of-pocket expenses, making it financially smart (for the individual) to work less and stay on Medicaid.

It’s important to emphasize that deciding to work less to receive more in government benefits is a financially rational decision for individuals to make, and one that any economist would readily predict. My hunch is that at least some of Obamacare’s architects knew this and designed their programs accordingly.

The problem, of course, is that convincing millions of people not to work is not financially sustainable for the country as a whole.

Yesterday, three senior Republican Senators introduced a set of ideas that could eventually turn into the upper chamber’s Obamacare alternative.

The proposal – coauthored by Senators Tom Coburn (Oklahoma), Richard Burr (North Carolina) and Orrin Hatch (Utah) – is a welcome companion to the repeal and reform plan put forward by the House Republican Study Committee (RSC).

The plans share some important elements. Both would repeal Obamacare (though the Senate plan would reinstate certain Medicare changes). Both limit medical malpractice awards in an attempt to cut down on junk lawsuits. And both would increase access to various tax-shielded vehicles like Health Savings Accounts.

An interesting divergence is over whether to allow consumers to purchase health insurance across state lines. The RSC bill does, while the Coburn-Burr-Hatch proposal does not. If allowed, consumers would have more choices, including access to cheaper out-of-state plans for those living in high regulation states.

On the other hand, there is the possibility that insurance companies might cluster in a low-regulation state, leading to a domino effect where all states cut back on coverage requirements or risk losing companies to more business-friendly states. Stripped down health insurance is fine for young and healthy people, but hardly adequate for older and sicker persons. If enough people are priced out of the market, expect the liberal solution to be expanding government programs to cover them.

We know, because that’s one of the arguments liberal defenders of Obamacare used to justify its passage. As Republicans deliberate on how best to reform Obamacare after it’s repealed, figuring out a way to avoid that trap should be high on the priority list.

If you know a young person who is unemployed, has no health insurance and spends waaay too much time using social media, the Obama administration has just the timewaster they’re looking for.

At tellafriendgetcovered.com, America’s healthiest non-working adults can absorb six straight hours of sales pitches and snarky humor trying to lure them into purchasing an Obamacare-approved health insurance policy that they probably won’t use.

One segment has a balding Richard Simmons bantering with a Miley Cyrus look-a-like. There are also ads featuring Oscar winner Jennifer Hudson, and former NBA stars Magic Johnson and Alonzo Mourning.

The one with Hudson portrays the starlet telling a distraught father of a recent college graduate not to worry – his uninsured son can stay on his company’s policy through age 26! All seems well in la-la land as father and son ignore the fact the company will be paying up to four more years to cover someone who isn’t helping the firm increase its revenue.

Sedentary viewers are encouraged to tweet, post and otherwise spread the fleeting joy they get from watching taxpayer-funded, government-directed infomericals. The goal is to create a social media buzz among young adults to increase their enrollment in Obamacare exchange plans.

The move is motivated by desperation. Currently, Obamacare-related enrollments by young and healthy people are at 24%. Originally, the Obama administration estimated that this cohort needed to be at least 40% of Obamacare’s risk pool to make it financially viable. The disparity could be disastrous.

If the White House’s celebrity-themed push doesn’t work, it won’t be for lack of creativity and spending. It will be because a sizeable number of young and healthy people wind up laughing at the administration’s pitch, not with it.

H/T: CNBC

James Taranto draws attention to an adverse selection problem revealed by the newest federal Obamacare enrollment numbers: More women than men are signing up for health insurance.

The gap between women and men enrollees is troublesome for President Obama’s signature law because women, on average, consume more health services than men. That higher rate of spending drives up the cost of future premiums for everyone.

Of course, women are a larger percentage of the population than men, so as long as the ratio on the federal exchange mirrors the ratio in the population, all should be well.

Except that current enrollment numbers – 54% women to 46% men – don’t mirror the population (where adult women outnumber adult men by a slight 50.3%).

It gets worse. “A 54% to 46% enrollment difference means that only 85.2 males are enrolled in Obamacare for every 100 females,” writes Taranto. Put simply, “Obamacare is missing more than 13 men for every 100 women who’ve signed up.”

Obamacare needs more men in its exchange pool just like it needs more young and healthy people – to pay for others with higher rates of health spending (i.e. women and older people, respectively). That the federal exchange is failing to attract people to pay more for coverage they don’t need is proof that everyday Americans aren’t the sheep central planners envision.

Thank goodness.

Karl Rove draws some much needed attention to the specific provision in Obamacare that increases the price young and healthy people pay for health insurance.

The “Adjusted Community Rating” in the law contains a ban on charging anyone a premium more than three times someone else’s. This new 3:1 ratio, called an “age rating band,” effectively prohibits insurers from pricing their product according to the age, health and lifestyle of the individual consumer (since to liberal ears that would be impermissible discrimination).

But by requiring insurers to treat everyone as if actuarial factors didn’t matter, Obamacare forces insurance companies to extract higher premiums from young and healthy people to pay for the care of older and sicker folks.

That’s why young people are paying more for health insurance under the misnamed “Affordable Care Act.”

As a policy matter, Obamacare insurance plans act as a wealth transfer from younger to older Americans.

Not that you’ll hear anyone in the Obama administration point that out. In fact, as Rove observes, they’re saying just the opposite.

Despite logic and evidence to the contrary, the National Press Secretary for the Department of Health and Human Services said last week that Obamacare “is making health insurance more affordable for young adults.”

Except that it isn’t. And unlike much of what the Obama administration says about Obamacare, that’s no lie.

Vermont is ready to start the first state-run single-payer system in the United States. There’s just one hitch: It needs federal taxpayers to foot the bill.

A state law passed in 2011 intends to create a state-run entity that “would largely sideline the insurance industry, and instead set up a government-managed system to collect all health care fees and pay out all health care costs,” reports Fox News.

But apparently, a program whose supporters estimate will save Vermont citizens a total of $1.9 billion from 2017-19 isn’t financially viable unless taxpayers living in the other 49 states chip in.

“In order for Green Mountain Care to fully launch in 2017, the health care exchange would have to get approval from the federal government to use federal money to fund the state program,” says the report.

It’s not clear from the article whether the federal money needed comes from Obamacare insurance subsidies or Medicaid (probably the former), but either way people living outside Vermont must fund a program that won’t benefit them, so that Green Mountain residents can live in a liberal utopia.

Simply put, if a majority of Vermont voters want to have a state-run single-payer system, they should raise their own taxes to the level necessary to pay for it.

Yesterday, Noam Scheiber of the New Republic defended Obamacare’s failings as a Machiavellian way for liberals to generate public support for even more government control of health care, eventually leading to the creation of a federally-run single-payer system.

“…the law created potentially millions of hard-working Americans who will have some health insurance; just maddeningly insufficient health insurance,” writes Scheiber. “What are the chances politicians stand up and take notice when these Americans complain?”

Fear not fellow liberals, says Scheiber, Obamacare’s disastrous rollout isn’t all bad news. “When you look at the big picture, the underlying political logic is clearly toward more generous, more comprehensive insurance, the natural upshot of cataloguing the law’s shortcomings isn’t to give them less insurance… It’s to give them more.”

In other words, Obamacare can be seen as a two-step process toward a federally-controlled national health system. First, individuals and employees are severed from their current insurance plans. Then, when they see how insufficient are the subsidies in paying for the government’s mandated coverage options, people will demand more money. The end result is having the feds pick up the entire bill as governments do in countries with socialized medicine.

A messy way to get what liberals want? Yes. But it’s worth the cost to pundits like Scheiber if in the end the liberal dream of nationalized health care becomes a reality.

A new study by a top flight team of academic researchers destroys the Obama administration’s premise for expanding Medicaid coverage.

The report, authored by researchers at MIT, Harvard and Columbia, focuses on an Oregon experiment to expand Medicaid that predates Obamacare by about five years. The findings show that giving Medicaid to an uninsured person increases the recipient’s visits to the emergency room up to 40 percent. This “runs counter to government assumptions that the newly insured would choose lower-cost options for care, such as doctors’ offices,” says Businessweek.

Avik Roy speculates that one of the reasons for why Medicaid enrollment increases unnecessary ER visits is that many doctors are refusing to accept new Medicaid patients because the federal government pays less than private insurance for the same service. Difficulty in obtaining primary care results in using the ER as the provider of first resort.

If the Oregon study is an accurate predictor of Medicaid patient behavior under Obamacare – and there is every reason to believe it is – then federal spending is about to soar.

With Obamacare’s Medicaid expansion already enrolling 3.9 million new people, the higher costs associated with emergency room visits could balloon actual spending far above the Obama administration’s current projections.

To make matters worse, previous research from Oregon shows that moving from no insurance to Medicaid does not improve health outcomes. Instead, it shifts the cost of care from the beneficiary to the taxpayer (and the provider who either eats the diminished compensation or passes it on to other patients).

So, to recap, Obamacare’s Medicaid expansion looks very likely to increase costs while having zero impact on the health of the beneficiaries.

Let this be a confirmation that the decision by governors who chose not to expand Medicaid under Obamacare was the sensible, scientifically proven way to go.

House Republicans are getting ready to ring in the New Year by focusing on Obamacare’s security risks.

As I’ve written previously, personal information entered into an account on Healthcare.gov – the federal Obamacare insurance exchange – may not be protected from identity thieves.

Amazingly, “Under current policy, an agency within the Department of Health and Human Services is tasked with deciding whether there is a risk of harm and whether individuals need to be notified whenever a security breach occurs,” says Fox News. “Republican lawmakers argue that the notification should not be optional.

A memo authored by House Majority Leader Eric Cantor (R-VA) calls for the chamber to vote on bills that would require HHS and its affiliates to notify the public if a security breach occurs.

Democrats are crying foul, but their opposition is self-serving. The only reason not to support the change to mandatory notice is to preserve the false sense of security that no notice means that all is safe.

President Obama once promised that his is “the most transparent administration in history.” The least he could do is apply that promise to the law that bears his name.

According to management experts, there are three pretty obvious reasons why the Obama administration was ill-prepared to make Heathcare.gov work.

“The heart of the issue, many of these people say, is that Obama and his inner circle had scant executive experience prior to arriving in the West Wing, and dim appreciation of the myriad ways the federal bureaucracy can frustrate an ambitious president,” reports Politico. “And above all, they had little apparent interest in the kind of organizational and motivational concepts that typically are the preoccupation of the most celebrated modern managers.”

In other words, no one in an Obamacare leadership position had relevant experience in this area. Worse, the President himself doesn’t appear to think this glaring deficiency matters.

It’s hard to fathom how a program so central to Obama’s legacy could be quarterbacked so poorly for so long, but here we are. The President thought that simply passing Obamacare would be enough to cement his status as one of the nation’s all-time greats. But if Republicans unite around an alternative and win back Congress this year, he’ll be lucky to leave office with anything resembling a workable program.

Since President Barack Obama refuses to replace any of his political appointees responsible for the epic bureaucratic failure that is Healthcare.gov, liberal supporters of health care reform are trying to turn the crisis into a potential power grab.

“Advocates have been quietly pushing the idea of a CEO who would set marketplace rules, coordinate with insurers and state regulators on the health plans offered for sale, supervise enrollment campaigns and oversee technology,” says a Reuters report.

The move would consolidate responsibility in the hands of one person that reports directly to the White House.

In other words, it would create a “Healthcare.gov Czar,” or, to use the title preferred by FDR when naming such deputies, a dictator.

Since no such position exists in the text of Obamacare, its creation would amount to a unilateral executive action by the President. Unlike the Secretary of Health and Human Services and the Director of the Centers for Medicare and Medicaid, the proposed dictator would not be confirmed by the U.S. Senate. If created, the position would be immune from virtually any oversight from Congress.

Moreover, erecting a Healthcare.gov CEO within the confines of the White House would be a fundamental rejection of the intended operating structure of Obamacare by the very President who signed it into law.

These reasons, plus others, may explain why the White House is said not to be entertaining such a drastic break with the health law’s basic architecture. Even they fear the likely blowback from a move that further centralizes political control of the health insurance industry.

Still, the fact that Obama’s most liberal supporters are pushing this idea – including Ezekiel Emanuel and wonks at the Center for American Progress – shows that the tendency on the Left is to interpret any problem in implementation as stemming from a lack of power. The endpoint for them is a single-payer system run exclusively by the feds.

Even if this proposal goes nowhere, its currency among the liberal elite shows us where this train is heading. Better to dismantle it before it passes the point of no return.

As Americans awake from the annual Christmas spending spree, a new set of bills is coming due in January – Obamacare-related taxes and fees.

The New York Post offers a summary:

·    A 2 percent levy on every health plan, which is expected to net about $8 billion for the government in 2014 and increase to $14.3 billion in 2018

·    A $2 fee per policy that goes into a new medical research trust called the Patient Centered Outcomes Research Institute

·    Insurers pay a 3.5 percent user fee to sell medical plans on the HealthCare.gov website, which is passed onto consumers

·    A 2.3 percent medical device tax that will inflate the cost of items such as pacemakers, stents and prosthetic limbs

·    An added 0.9 percent Medicare surtax on top of the existing 1.45 percent Medicare payroll tax for families making over $200,000 and individuals making more than $250,000 annually

·    The same groups will also pay an extra 3.8 percent Medicare tax on unearned income, such as investment dividends, rental income and capital gains

The government Grinches even swiped the income tax deduction for medical expenses that exceed 7.5 percent of a person’s annual income. In 2014 it will jump to 10 percent.

‘Tis the season for a heavier tax burden.

If you’re fretting over whether to interrupt Christmas Eve activities to sign up for an Obamacare insurance plan, fear not.

“Today’s the deadline to sign up for health insurance on HealthCare.gov if you want that insurance to start by January 1st. But that’s it,” explains Ezra Klein. “If you don’t sign up today and instead sign up on Friday, or next Tuesday, your insurance will kick in a bit after January 1st. There’s no difference in premiums. There’s no difference in plans. There are no penalties.”

I bolded the last sentence to draw attention to an important piece of information often missed in the reporting about the January 1st start date. As Klein says, “The [individual] mandate only kicks in when people have a coverage gap of longer than three consecutive months during the year. That means that buying insurance any time before the end of March [i.e. the end of the open enrollment period on the exchanges] is good enough to avoid the penalty.”

The upshot: Maybe by March the federal government will have fixed all the problems with Obamacare. Maybe. For now, enjoy the Christmas season.

With the Obama administration fearing a surge of users trying to enroll in an Obamacare exchange insurance plan ahead of the midnight deadline today, government officials and IT contractors extended the cutoff over the weekend without bothering to issue a public notice.

The new deadline is midnight of Christmas Eve.

For those trying to lock-in coverage by January 1st – and thus avoid an IRS penalty – the extension is good news. But for the insurance industry, it’s another unwelcome, unaccountable administrative fiat.

“The extension, said the sources, cannot be overridden by insurance companies if they object to it,” reports National Review Online. “It is the latest of several last-minute, ad hoc rule changes issued by the administration, including last week’s announcement that individuals whose insurance plans were [canceled] may receive an exemption from the Affordable Care Act’s individual mandate.”

Until Obamacare is repealed and the federal government is divested of its power to dictate – and change – so many important terms at its whim, volatility in the health insurance market looks like it’s here to stay.

Late yesterday, the Department of Health and Human Services (HHS) announced that anyone whose individual insurance policy was cancelled due to Obamacare and now has to pay for a more expensive plan is exempt from the individual mandate until 2015.

You read that right. The individual mandate – the keystone of Obamacare’s coverage and funding structure – no longer applies to an estimated 5 million Americans.

This is HUGE. By granting this carve-out, the Obama administration has voluntarily weakened the mechanism that is supposed to guarantee insurance companies selling plans through an Obamacare exchange sufficient numbers of people to fill out their risk pools.

Now, suddenly, these companies are facing the very real possibility that millions of people will choose to hold off buying insurance until they get sick. The new exemption changes a consumer’s calculation. Prior to yesterday, all the emphasis was on signing up by the December 23rd deadline to avoid a 2014 tax penalty.

Now, for up to 5 million people, the decision point to buy insurance occurs when they get sick. Thus, insurance companies won’t get to spread the risk of illness by banking premium payments from healthy people. Many more people buying insurance going forward will need costly care the moment they sign up.

In other words, this move destroys the nature of insurance.

It’s also indefensible as a matter of justice to require the uninsured to comply with the mandate.

“Put more simply, Republicans will immediately begin calling for the uninsured to get this same exemption. What will the Obama administration say in response? Why are people whose plans were cancelled more deserving of help than people who couldn’t afford a plan in the first place?” asks Ezra Klein.

As I said in my column this week, Obamacare’s failures are completely that fault of its supporters. Republicans shouldn’t help fix something that is so broken. 2014 should be the year the GOP unites around a viable alternative to replace this monstrosity after it is repealed.