Many liberals probably think that President Obama’s
re-election assures once and for all that ObamaCare will be implemented.
Nothing could be further from the truth. Not only does the bill remain very
unpopular (three-fifths of Americans disapprove of it in current polls), but
some of the unwieldy and sneaky provisions written into the massive bill in its
hasty preparation are already coming apart.
First, although the Supreme Court ruled that the individual
mandate was constitutional (but as a tax, not as a power granted under the
interstate commerce clause), it also ruled that the federal government could
not force states to expand Medicare, nor penalize them if they chose not to. Many states, perhaps eventually a majority,
are using that ruling to refuse to expand Medicare, since it increases the
state’s Medicare costs, requiring more taxes.
Since many states are already having trouble funding their existing
Medicare obligations, they are quite wisely not about to make the problem worse
if they can avoid it.
Now the problem for the administration is this – hospitals,
insurance companies and health care providers were counting on the subsidies
and added business from this Medicare expansion to offset some of the cuts they
agreed to, and some of the new features of the law, like the pre-existing condition
clause. Suddenly this offset is no
longer there, and you can bet these lobbies will be back to their Congressmen
to change the law to fix this somehow.
Second, ObamaCare expects the states to create health insurance
exchanges (but of course without sending the states any money to fund this
activity). Contrary to the bill’s
expectations, some 30 of the states have already refused to create such
exchanges. Since they don’t have to (the same Supreme Court ruling reaffirmed
the principle that Congress cannot command states to run a federal program),
most are not going to take on the financial burden of staffing and running a
federal program they don’t think they need.
The law requires the federal government to create such an exchange if
the states don’t, but didn’t provide any funds for the federal government to do
that either.
Now the administration’s problem with this is that these state
exchanges were a sneaky way to embed and hide some $800 billion in subsidies
and tax credits so that they wouldn’t count against ObamaCare’s total cost. But suddenly this mechanism isn’t available,
so the increased costs are now clearly visible. More than that, the employer penalties
for not offering employees adequate insurance were tied to these state
exchanges. No state exchange – no employer tax penalties. You can bet companies
will soon start to move from any state with a state exchange to neighboring
states without the exchanges.
So this battle is far from over, and in the end it probably
won’t be Republican opposition that sinks most of the bill, but the simple
unworkability and fiscal unsustainability of it. The math never did make sense – one cannot
insure millions more people without it costing a lot more money, however hard
one tries to hide the cost. One cannot expand the Medicare rolls by millions of
people without it costing a lot more money, which has to come from somewhere.
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