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Are You Indian Enough to Be Exempt from Obamacare?
Ilya Shapiro
You can’t make this up: Obamacare exempts certain American Indians from the “choice” Americans will face as of January of buying health insurance or paying Chief Justice Roberts’s special tax. But apparently this is a far narrower category of people than those recognized as “Indian” under various state laws:
The problem is so new that the federal government is still seeking to establish how many people might be affected, although Indian health advocacy groups estimate it could be up to 480,000.
In California alone, about 21,000 people who currently receive free health care through Indian clinics are not recognized as Native American by the federal government and would have to pay the penalty, according to the nonprofit California Rural Indian Health Board.
So people who’ve considered themselves American Indian all their lives and have been treated as such by their states–including for health care purposes–suddenly won’t be considered Indian as far as Obamacare is concerned.
Wow–Indian law is complicated and constitutionally problematic enough without having further regulatory overlays bollix up the works even more. But that’s what happens when government encoraches more and more into civil society. As I wrote in January in an article on, of all things, the contraceptive mandate:
But there’s an even bigger issue here. This is just the latest example of the difficulties in turning health care—or increasing parts of our economy more broadly—over to the government. As my colleague Roger Pilon has written, when health care (or anything) is socialized or treated as a public utility, we’re forced to fight for every “carve-out” of liberty…
The more government controls—whether health care, education, or even marriage—the greater the battles over conflicting values. With certain things, such as national defense, basic infrastructure, clean air and water and other “public goods,” we largely agree, at least inside reasonable margins. But we have vast disagreements about social programs, economic regulation and so much else that government now dominates at the expense of individual liberty.
Obamacare delenda est.
View full post on Cato @ Liberty
Low-Skilled Workers Get Raw Deal Under Obamacare
Looks like under Obamacare many lower skilled workers will end up with “skinny” or “band aid” health insurance plans which may cover a few doctors visits and some prescriptions but may leave the insured exposed to catastrophic loss. This is exactly what we don’t need.
(From Real Clear Politics)
But larger employers, they write, “need only cover preventive service, without a lifetime or annual dollar-value limit, in order to avoid the across-the-workforce penalty.” Low-benefit plans may cost an employer only $40 to $100 a month per employee. That’s less than the $2,000-per-employee penalty for providing no insurance.
“We wouldn’t have anticipated that there’d be demand for these type of Band-Aid plans in 2014,” the Journal quotes former White House health adviser Robert Kocher. “Our expectation was that employers would offer high-quality insurance.”
Oops. It turns out that Friedrich Hayek may have been right when he wrote that central planners would never have enough information to micromanage the economy.
View full post on AgainstCronyCapitalism.org
Tyranny of the Minority, ObamaCare Edition
Michael F. Cannon
A Fox News poll released Wednesday finds that while 26 percent of voters say their health care situation will be better under the new law, twice as many – 53 percent – say it will be worse. Another 13 percent say it won’t make a difference…
That helps explains why a 56-percent majority wants to go back to the health care system that was in place in 2009. Some 34 percent would stick with the new law.
View full post on Cato @ Liberty
WSJ: ObamaCare Could Reduce Employee Health Benefits
Michael F. Cannon
ObamaCare supporters promised the law’s employer mandate would require employers to provide workers with comprehensive insurance. But they apparently didn’t read the bill very closely. It’s a recurring theme.
According to the Wall Street Journal, employers and employee-benefits consultants have found, and federal regulators now confirm, that the law actually requires most employers to offer no more than very flimsy coverage. Many employers are now exploring the option of offering limited-benefit health plans that cover preventive services and maybe “$100 a day for a hospital visit” but “wouldn’t cover surgery, X-rays or prenatal care.” Indeed, the law could push many employers to reduce the amount of coverage workers receive on the job.
The Obama administration’s reaction demonstrates they had no idea what they were doing. The Wall Street Journal:
Administration officials confirmed in interviews that the skinny plans, in concept, would be sufficient to avoid the across-the-workforce penalty. Several expressed surprise that employers would consider the approach.
“We wouldn’t have anticipated that there’d be demand for these types of band-aid plans in 2014,” said Robert Kocher, a former White House health adviser who helped shepherd the law. “Our expectation was that employers would offer high quality insurance.”
The Law of Unintended Consequences strikes again.
This and other employer responses to the law could make the roll-out of ObamaCare’s health insurance “exchanges” even more of a train wreck.
- To the extent ObamaCare’s employer mandate pushes firms to offer bare-bones plans, premiums for plans offered through Exchanges will rise. The healthiest workers will enroll in their employers’ bare-bones plans, but workers who have expensive illnesses (or with dependents who have expensive illnesses) will seek more-comprehensive coverage through the Exchanges. The influx of sick consumers will increase the premiums for Exchange-based plans. Many of these sick workers won’t receive any premium-assistance tax credits or cost-sharing subsidies because their employer’s bare-bones plan will likely satisfy ObamaCare’s definition of adequate – and because the statute forbids those entitlements in the 33 states that have declined to establish an Exchange.
- Employers are also renenwing their health-benefits contracts early (i.e., before January 1, 2014), which allows them to avoid many of ObamaCare’s regulatory costs for several months. That move could also increase premiums for Exchange-based plans by encouraging workers with high-cost illnesses to seek coverage through Exchanges while healthy workers stick with their employer’s plans.
- Many employers are also considering self-insuring their health benefits, an arrangement in which the employer bears the risk that is usually borne by the insurance carrier and just hires someone (often an insurer) to administer the coverage. This strategy allows also employers to avoid many of ObamaCare’s regulatory costs and could also increase premiums in the Exchanges and small-group market.
Again, the Journal:
Regulators worry that some of these strategies, if widely employed, could pose challenges to the new online health-insurance exchanges that are a centerpiece of the health law. Among employees offered low-benefit plans, sicker workers who need more coverage may be most likely to opt out of employer coverage and join the exchanges. That could drive up costs in the marketplaces.
These are the sort of unintended consequences that ObamaCare’s opponents warned would plague any attempt by Congress to centrally plan one-sixth of the U.S. economy.
View full post on Cato @ Liberty
Poll: Already Scant Support for Obamacare Erodes
Michael F. Cannon
According to the latest Reason-Rupe poll:
The president’s health care law is losing public support… Only 32 percent of Americans say they liked the health care law when it was passed and still like it today. Seven percent liked the law when it was passed, but like it less now. Meanwhile, 45 percent disliked the health care law when it was passed and still dislike it. Four percent of Americans say they disliked the law when it passed, but like it more now.
These results are consistent with the Kaiser Family Foundation Health Tracking Poll, which has always reported a higher level of support for the law than other polls, yet whose latest results show support for Obamacare slipping to just 35 percent of adults.
View full post on Cato @ Liberty
Sebelius Shakes Down Companies She Regulates for Cash to Implement ObamaCare
Michael F. Cannon
Secretary of Health and Human Services Kathleen Sebelius’ latest abuse of power has strengthened the case for her removal from office. Before discussing her latest misconduct, let’s review some of Sebelius’ past abuses of power.
- In 2010, Sebelius described anonymous political speech as “dangerous.” (The IRS’s recent targeting of tea-party groups is a good argument for protecting anonymous speech.)
- So too is Sebelius’ 2010 threat to put health insurance companies out of business. Shortly after ObamaCare became law, insurers began telling their customers how much it was going to increase their premiums. In a September 2010 letter to insurers, Sebelius shot back that premiums would rise no more than 2 percent, even as her department predicted increases as high as 7 percent. Insurers that didn’t toe the party line “may be excluded from health insurance Exchanges in 2014.” That was no idle threat, I wrote at the time. Since “Medicare’s chief actuary predicts that in the future, ‘essentially all‘ Americans will get their health insurance through those exchanges,” Sebelius was essentially threatening to put insurers out of business if they disagreed with her.
- In 2011, Sebelius has approved her department issuing hundreds of billions of dollars in subsidies to private health insurance companies under the rubric of ObamaCare that the statute expressly forbids HHS to issue.
- In 2012, the U.S. Office of Special Counsel concluded that Sebelius violated the Hatch Act by campaigning for President Obama and other political candidates while traveling on official business, an offense for which other federal workers are fired.
- In a July 2012 letter to the nation’s governors, Sebelius arbitrarily rewrote and narrowed the Supreme Court’s ruling in NFIB v. Sebelius to allow HHS to continue coercing states into implementing parts of ObamaCare’s Medicaid expansion.
- When it became apparent that two-thirds of states would not implement one of ObamaCare’s health insurance “exchanges,” Sebelius dismissed the idea that a lack of congressionally authorized funding for federal Exchanges would stop her department from implementing them. “We are going to get it done,” she said. Now we learn she substituted her own judgment for Congress’ by raiding ObamaCare’s Prevention and Public Health Fund to the tune of $454 million to fund federal Exchanges. But even that wasn’t enough.
Now we learn, from the Washington Post’s Sara Kliff, “Sebelius has, over the past three months, made multiple phone calls to health industry executives, community organizations and church groups and directly asked that they contribute to non-profits that are working to enroll uninsured Americans and increase awareness of the law.”
This too appears to be unlawful:
Federal regulations do not allow department officials to fundraise in their professional capacity. They do, however, allow cabinet members to solicit donations as private citizens “if you do not solicit funds from a subordinate or from someone who has or seeks business with the Department, and you do not use your official title,” according to Justice department regulations.[A] Health and Human Services official, who requested anonymity because he was not authorized to discuss the secretary’s private discussions, described her work as well within the bounds of her authority.
Riiight. Kathleen Sebelius runs the Department of Health and Human Services. At nearly $1 trillion per year, HHS is the largest department in the U.S. government, spending 43 percent more than the Defense Department. Most of those subsidies go to the health care sector. Those subsidies will increase dramatically when ObamaCare takes full effect next year. Sebelius has been calling executives from the industry she regulates, including “multiple insurance executives,” and asking them to donate money to Enroll America – a private organization, headed by a former White House official, whose purpose is to help make ObamaCare a success. Sebelius has a history of threatening uncooperative companies with retaliation. But we are to believe it’s all on the up and up because…what? She never told these executives whether she is the Kathleen Sebelius who runs HHS, or some other Kathleen Sebelius?
Even if her activities are not illegal, they are definitely unethical:
“It sounds like the people she’s going to are people that are being regulated by her agency, I think that is definitely problematic,” said Meredith McGehee, policy director for the Campaign Legal Center. “That’s not a statement about the value of the law, but it’s a statement about using the power of government to compel giving or insinuate that giving is going to be looked at favorably by the government.”
Given this much misconduct, you might think President Obama would ask for Sebelius’ resignation. A spokesman for the president commented:
The President believes that the American people expect and deserve to have the very best public servants with the highest levels of integrity working in government agencies on their behalf…If the Inspector General finds that there were any rules broken or that conduct of government officials did not meet the standards required of them, the President expects that swift and appropriate steps will be taken to address any misconduct.
I’m kidding, of course. That’s what White House press secretary Jay Carney said about the IRS targeting tea-party groups. Sebelius is all aces with the president, for two reasons. First, her misconduct came in the service of universal coverage. To the Church of Universal Coverage, there is no higher law. Second, the president needs Sebelius because she is the only person in the universe who can wield the considerable powers of ObamaCare’s Independent Payment Advisory Board without needing a Senate confirmation hearing.
As I wrote on the eve of ObamaCare’s passage, “Abandoning ethics to serve one’s partisan agenda is an ugly yet bipartisan tradition. But there’s an added irony when supporters of ObamaCare do it: at the same time they demonstrate what scant regard politicians have for honesty, propriety, fair play, and even public opinion, they are demanding that we trust politicians with our health care.”
View full post on Cato @ Liberty
Benghazi? Let’s Talk ObamaCare!
Michael F. Cannon
Things must be going poorly for President Obama if he wants to change the subject to ObamaCare.
Today, most of Washington is questioning whether the U.S. government was derelict in its handling of the September 11, 2012 assault on the U.S. consulate in Benghazi, Libya, in which heavily armed assailants injured 10 Americans and murdered four, including the U.S. ambassador. However, over at the White House, President Obama is launching a PR defensive of ObamaCare, at which he will basically ask mothers to nag their kids to waste their money on ObamaCare’s over-priced health insurance.
The contrast brought to mind this passage from University of Chicago law professor M. Todd Henderson’s article in the latest issue of Cato’s Regulation magazine:
When the president sought to make birth control a mandatory part of all insurance plans, this was a political decision regarding health care. This is not to disparage political decisions in general, but merely to point out this feature of them, that they bind those who disagree…
A relatively simple, low cost, and widely accepted practice like birth control became a firestorm when individual choice and local variation were overridden on the grounds of improving social welfare. The airwaves and print media were filled with analysis, name-calling, and hyperbole. Kitchen tables, like my own, were filled with debate about how we should vote about the financing of other peoples’ use of birth control… Just imagine what the debates will look like when the stakes become—as they inevitably will—whether expensive cancer therapies, surgeries, or other procedures will be paid for, or whether more controversial matters like abortion, gender reassignment, and the like will be paid for…
When … matters are decided by experts or politicians, mistakes can be made and made in ways that necessarily are coercive. This coercion does not admit easy exit, as one can exit an insurance policy, especially if done at the federal level. The central lesson is that centralized power over complex matters risks making larger mistakes than decentralized power, admits less innovation, provides for less tailored satisfaction of preferences, and generates greater political conflict. Ironically, those risks may undermine the important work that government must do to improve the world we live in.
Every minute the government spends trying (and failing) to improve people’s health is a minute it cannot spend making them safer.
Read the rest of Henderson’s article, “Voice and Exit in Health Care Policy.”
View full post on Cato @ Liberty
Obamacare Train Wreck? Washington Post: Obama Administration “has gone hat in hand to health industry executives.”
Obamacare looks increasingly like a disaster. It could be Obama’s Iraq War. (Sadly it’s even more expensive.) Senator Baucus, a Democrat, recently said he saw an Obamacare “train wreck coming down.”
Then he announced his retirement.
Obamacare, which was forced through against the will of a majority of Americans according to polling at the time, has the potential to get very ugly indeed. And the law has only gotten more unpopular with time. Things are going so badly that Kathleen Sebelius now has to beg for funds from health industry executives (you know the people who wrote large parts of the law) to get the thing off the ground.
In other words she is playing the crony card, giving industry another chance to show which companies really want to play ball with the government, and of course reap (potential) benefits.
Thing is we may be past that point Ms. Sebelius. And as Baucus saw, you and the administration are running out of track.
(From The Washington Post)
“It sounds like the people she’s going to are people that are being regulated by her agency, I think that is definitely problematic,” said Meredith McGehee, policy director for the Campaign Legal Center. “That’s not a statement about the value of the law, but it’s a statement about using the power of government to compel giving or insinuate that giving is going to be looked at favorably by the government.”
View full post on AgainstCronyCapitalism.org
IRS Chief, Who Defended Illegal ‘ObamaCare’ Taxes, also Denied Targeting of Tea-Party Groups
Michael F. Cannon
In 2011, members of Congress began criticizing a proposed IRS rule implementing ObamaCare’s health insurance tax credits. They claimed that the proposed rule violated the clear language of the Patient Protection and Affordable Care Act, as well as congressional intent, by issuing those tax credits in states that declined to establish a health insurance “exchange.” In effect, they claimed the proposed rule would result in the federal government taxing, borrowing, and spending hundreds of billions of dollars without congressional authorization.
At the time, then–IRS commissioner Douglas Shulman leapt to his agency’s defense. He wrote that various provisions of the statute “support” the rule. He wrote that the “relevant” legislative history doesn’t show that Congress didn’t want the IRS to tax, borrow, and spend those hundreds of billions of dollars. He wrote that the proposed rule is “consistent with the language, purpose, and structure” of the law. The only thing he didn’t do was cite a provision of the law authorizing the rule, or even creating any ambiguity about the rule’s illegality.
The IRS finalized that illegal rule in May 2012. You can read all about it in my article with Jonathan Adler, “Taxation Without Representation: The Illegal IRS Rule to Expand Tax Credits Under the PPACA.”
It is worth noting that Shulman also leapt to the IRS’s defense against another charge that the agency was abusing its power. In 2012, conservative groups complained that the IRS was targeting them for audits. Shulman issued a forceful and categorical denial:
IRS Commissioner Douglas Shulman told Congress in March 2012 that the IRS was not targeting groups based on their political views.
“There’s absolutely no targeting. This is the kind of back and forth that happens to people” who apply for tax-exempt status, Shulman told a House Ways and Means subcommittee.
Shulman was wrong. Today, the IRS admitted it has been targeting conservative groups for audits.
Perhaps some Friday afternoon hence we will be treated to an IRS admission that their tax-credit rule violates the Administrative Procedures Act and the PPACA, as two lawsuits now allege. I won’t hold my breath.
View full post on Cato @ Liberty