We interrupt this wall-to-wall coverage of the Supreme Court’s ruling to point out yet more evidence that Obamacare did nothing to reduce health costs. Reuters reported yesterday on a report on health spending from the Organization for Economic Cooperation and Development (OECD):
Growth in health spending reversed a long-term trend of rapid increase and either slowed or fell in real terms in most OECD countries in 2010…Overall health spending grew by nearly 5 percent a year in real terms in the 34 countries…between 2000-2009, but this was followed by zero growth in 2010…The OECD also said preliminary figures for a limited number of countries suggest there was little or no growth in health spending in 2011.
In other words, the slowdown in American health care spending is nothing unusual – it’s happening worldwide. And it is NOT occurring because of Obamacare; it’s taking place because of the global economic downturn. Spending growth has been slower than projected NOT because Obamacare worked, but because the Obama “stimulus” didn’t.
What IS unusual about American health care is the growth in government spending on health programs. The OECD found that “the health in total health spending in 2010 was driven by a fall of 0.5 percent in public spending for health, following an increase of over 5 percent per year in 2008 and 2009.” So while other governments are reducing spending on health programs and entitlements, the United States – at a time of trillion-dollar deficits – is embarking on a $2.6 trillion coverage expansion. It’s one more sign that under Obamacare, government spending really is doing fine.
Reactions to yesterday’s Supreme Court ruling keep pouring in, and some of them have been, well, interesting. In an interview with ABC News, Nancy Pelosi called Obamacare “a market-oriented, private sector-oriented piece of legislation.”
The former Speaker famously asked “Are you serious?” when it came to Obamacare’s constitutionality. (Which is ironic, because even Elena Kagan and Stephen Breyer ruled part of the law unconstitutional yesterday.) But our only response to Pelosi’s claim that Obamacare is market-oriented has to channel “Airplane!” “Surely you can’t be serious!”
Here are just ten reasons why Obamacare is a massive intrusion of government into the private lives and health care decisions of all Americans:
- Taxes American Businesses that do not provide Government Approved Health Plans. Beginning in 2014, businesses with more than 50 employees will be taxed $2,000 per employee if they do not provide government-approved health insurance for their employees.
- Forces More Americans into Medicaid – A Broken, Bankrupt Government Entitlement Program. The current Medicaid program is already bankrupting states and the federal government, yet the new law forces 25.9 million more people into this broken program. Medicaid patients are already denied access to about 40 percent of physicians because reimbursements are so low. Half those newly “insured” under the health care law will get their coverage through this government program – Medicaid.
- Puts The Federal Government In Charge of Your Health Insurance. The law created new rules and regulations for all health insurance in America. The government will decide what type of health care you must to purchase, what your plan must to cover and how much it costs. Even if you want to purchase a lower cost plan, you can’t.
- By one count, the law creates 159 new boards, offices, and panels in the Federal Government to make decisions about your health care. The Congressional Research Service determined that trying to count the endless number of new bureaucratic entities was “impossible” and an official count was “unknowable.”
- Gives the Obama Administration Secretary of Health and Human Services More Than 1,700 New or Expanded Powers – to Exert Control Over the Lives and Personal Health Care Decisions of Americans.
- Levies more than $550 billion dollars of taxes, fees, and penalties related to health care on American families and employers.
- Spends Tens of Billions of Taxpayer Dollars Just to Implement the Massive New Law. In their cost estimate of the law, the Congressional Budget Office said it could cost as much as $20 billion for the Internal Revenue Service and the Department of Health and Human Services just to implement the law.
- Creates a New Panel of Government Bureaucrats to Cut Medicare. The Democrats’ law created a panel of politically-appointed bureaucrats who have the power to effectively to write laws regarding Medicare. Under the law, unelected and unaccountable bureaucrats will make personal Medicare decisions that automatically take effect unless Congress intervenes.
- Micromanages how patients can spend their own tax-free health care dollars. Under the law, the government imposes onerous new requirements on tax-free savings accounts that will limit their use and create costly barriers to qualified products by prohibiting the purchase of over the counter medical products unless prescribed by a doctor. Items such as pain relievers, cough medicine, and allergy medicine will now require a costly visit to the physician if an individual would like to purchase that item with the funds from their account.
- The law’s 2,700 pages was just the beginning, as Washington bureaucrats have written more than 12,000 pages – and counting – of additional regulations to restrict personal freedom and micromanage the private market. These massive new mandates being rolled out every day by Washington are increasing uncertainty, and making it difficult for small firms to expand and grow their businesses.
Former Speaker Pelosi – she of “we have to pass the bill to find out what’s in it” fame – may still have not read the 2700-page law, and therefore remains unaware of the government overreach included in it. But the American people know about all the mandates, regulations, and bureaucracy in the law, which is why the only thing bipartisan about Obamacare has been the opposition to it.
Judging from much of the media coverage of the Supreme Court’s ruling over the past 24 hours, one would think the law had been given a clean bill of constitutionality by the Court, meaning Obamacare faces smooth sailing from here on in. But as ESPN’s Lee Corso might say, “Not so fast, my friend!”
First, as we pointed out yesterday, part of Obamacare WAS ruled unconstitutional by the Court – and by a 7-2 margin, no less. That bears worth repeating: Even Justices Elena Kagan – one of President Obama’s appointees, and his former Solicitor General – and Steven Breyer – a former Ted Kennedy staffer – thought Obamacare’s Medicaid expansion was unconstitutionally coercive. So much for “Are you serious?”
Second, Obamacare faces continued obstacles on numerous fronts, including in the courts:
- (More) Constitutional Uncertainty: Other Obamacare provisions are subject to constitutional litigation. For instance, the law’s Independent Payment Advisory Board – that bureaucratic spawn so dangerous President Obama is afraid to appoint nominees to it during his re-election campaign – has been challenged as giving unelected and unaccountable officials carte blanche to re-write Medicare policy, thereby usurping the role of Congress. Former Obama Administration budget chief Peter Orszag thinks IPAB is one of the lynchpins of the law, precisely because it is constitutionally questionable – or, as he put it, “less democratic.”
- Legal Uncertainty: Challenges to other elements of the law – such as its infringements on religious liberty – that had been delayed during the Supreme Court’s consideration will now proceed apace. Also likely subject to a legal challenge is the Administration’s regulatory ruling indicating that individuals in a federal exchange can receive insurance subsidies – which appears to violate the plain text of the statute.
- Funding Uncertainty: While some implementation funding was included in the law, most of that money has been spent – meaning the Administration has to come back to Congress for more money through the annual appropriations process. Amidst all the reaction to the Court ruling yesterday, many may have missed the fact that the White House issued a veto threat against an appropriations measure being considered in the House, in part because the appropriations bill restricts funding to the IRS for implementation of Obamacare – including implementation of the health insurance mandate tax. As a reminder, Obamacare does NOT give HHS mandatory funding to establish a federally-based exchange, which is why the Administration requested more than half a billion dollars in new discretionary funding for a federal exchange in its budget this February. Given that the federal government is running trillion-dollar deficits, why does anyone think Congress should be favorably inclined to spend billions more implementing a law the Supreme Court has admitted is a constitutional overreach?
- State Uncertainty: Yesterday’s ruling gave states the ability to opt out of the law’s new Medicaid expansion – which according to the Medicare actuary accounts for more than half of the law’s coverage expansions – without giving up their existing Medicaid funding. States can also decide not to create state-based exchanges, and many have declined to create them. Even Tom Daschle, President Obama’s once-putative HHS Secretary, admitted that the law is so cumbersome and unwieldy that states are unlikely to be ready for its “Big Bang” in January 2014. And yesterday’s ruling should not give states any more incentive to implement an unconstitutional law – it may well give them less incentive to do so.
- Electoral Uncertainty: This topic should be self-evident. However, it does give me the opportunity to point out the conservative justices’ observation in their dissent that “cutting Medicare is unpopular” (page 59). Which is a delicate way of pointing out that senior citizens may not like the idea that Obamacare uses more than $500 billion in Medicare savings not to improve Medicare’s financial stability, but to create a new entitlement. And as President Obama likes to say, “Elections have consequences.”
- Overall Uncertainty: Even as the Administration attempts to claim victory and certainty on implementation, the true picture is far from clear:
- States could opt out of the Medicaid expansion;
- More states could choose not to create Exchanges;
- The federal government could lack the resources necessary to create a federal Exchange;
- Courts could overrule federal bureaucrats’ arbitrary decision, and decide that Obamacare does NOT authorize insurance subsidies to those enrolled in a federal Exchange – thus undermining both the subsidy regime and the employer mandate.
The most important point is this: The American people don’t want this unconstitutional law – and they never have. To argue that implementation will proceed full-speed ahead – in the face of public opinion, the significant obstacles ahead, and a Supreme Court ruling calling parts of the law unconstitutionally coercive – may strike some as whistling past the graveyard.
46 50 Reasons to Repeal ALL of Obamacare NOW
Today the Supreme Court struck down portions of Obamacare as unconstitutional – states cannot be “dragooned” into expanding their Medicaid programs according to the law’s dictates. However, a list of 50 particularly onerous or egregious provisions in Obamacare (with sections from the statute duly noted) reveals just how much of this bad law remains. By the most generous interpretation, the Court struck down only four of the 50 egregious policies, illustrating why Congress should immediately repeal the entire measure once and for all. Among many other bad policies, the law:
- Imposes $800 billion in tax increases, including no fewer than 12 separate provisions breaking candidate Obama’s “firm pledge” during his campaign that he would not raise “any of your taxes” (Sections 9001-9016)
- Forces Americans to purchase a product for the first time ever (Section 1501)
- Creates a board of 15 unelected and unaccountable bureaucrats to make binding rulings on how to reduce Medicare spending (Section 3403)
- Pays over $800 billion in subsidies straight to health insurance companies (Sections 1401, 1402, and 1412)
- Requires all individuals to buy government-approved health insurance plans, imposing new mandates that will raise individual insurance premiums by an average of $2,100 per family (Section 1302)
- Forces seniors to lose their current health care, by enacting Medicare Advantage cuts that by 2017 will cut enrollment in half, and cut plan choices by two-thirds (Section 3201)
- Imposes a 40 percent tax on health benefits, a direct contradiction of Barack Obama’s campaign promises (Section 9001)
- Relies upon government bureaucrats to “issue guidance on best practices of plain language writing” (Section 1311(e)(3)(B))
- Provides special benefits to residents of Libby, Montana – home of Max Baucus, the powerful Chairman of the Senate Finance Committee, who helped write the law even though he says he hasn’t read it (Section 10323)
- Imposes what a Democrat Governor called the “mother of all unfunded mandates” – new, Washington-dictated requirements of at least $118 billion – at a time when states already face budget deficits totaling a collective $175 billion (Section 2001)
- Imposes reductions in Medicare spending that, according to the program’s non-partisan actuary, would cause 40 percent of all Medicare providers to become unprofitable, and could lead to their exit from the program (Section 3401)
- Raises premiums on more than 17 million seniors participating in Medicare Part D, so that Big Pharma can benefit from its “rock-solid deal” struck behind closed doors with President Obama and Congressional Democrats (Section 3301)
- Creates an institute to undertake research that, according to one draft Committee report prepared by Democrats, could mean that “more expensive [treatments] will no longer be prescribed” (Section 6301)
- Creates a multi-billion dollar “slush fund” doled out solely by federal bureaucrats, which has already been used to fund things like bike paths (Section 4002)
- Subjects states to myriad new lawsuits, by forcing them to assume legal liability for delivering services to Medicaid patients for the first time in that program’s history (Section 2304)
- Permits taxpayer dollars to flow to health plans that fund abortion, in a sharp deviation from prior practice under Democrat and Republican Administrations (Section 1303)
- Empowers bureaucrats on a board that has ruled against mammograms and against prostate cancer screenings to make binding determinations about what types of preventive services should be covered (Sections 2713 and 4104)
- Precludes poor individuals from having a choice of health care plans by automatically dumping them in the Medicaid program (Section 1413(a))
- Creates a new entitlement program that one Democrat called “a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of” – a scheme so unsustainable even the Administration was forced to admit it would not work (Section 8002)
- Provides $5 billion in taxpayer dollars to a fund that has largely served to bail out unions and other organizations who made unsustainable health care promises to retirees that they cannot afford (Section 1102)
- Creates a tax credit so convoluted it requires seven different worksheets to determine eligibility (Section 1421)
- Imposes multiple penalties on those who marry, by reducing subsidies (and increasing taxes) for married couples when compared to two individuals cohabiting together (Sections 1401-02)
- Extends the Medicare “payroll tax” to unearned income for the first time ever, including new taxes on the sale of some homes (Section 1402)
- Impedes state flexibility by requiring Medicaid programs to offer a specific package of benefits, including benefits like family planning services (Sections 2001(a)(2), 2001(c), 1302(b), and 2303(c))
- Requires individuals to go to the doctor and get a prescription in order to spend their own Flexible Spending Account money on over-the-counter medicines (Section 9003)
- Expands the definition of “low-income” to make 63 percent of non-elderly Americans eligible for “low-income” subsidized insurance (Section 1401)
- Imposes a new tax on the makers of goods like pacemakers and hearing aids (Section 9009)
- Creates an insurance reimbursement scheme that could result in the federal government obtaining Americans’ medical records (Section 1343)
- Permits states to make individuals presumptively eligible for Medicaid for unlimited 60-day periods, thus allowing any individual to receive taxpayer-funded assistance ad infinitum (Section 2303(b))
- Allows individuals to purchase insurance on government exchanges – and to receive taxpayer-funded insurance subsidies – WITHOUT verifying their identity as American citizens (Section 1411)
- Gives $300 million in higher Medicaid reimbursements to one state as part of the infamous “Louisiana Purchase” – described by ABC News as “what…it take[s] to get a wavering senator to vote for health care reform” (Section 2006)
- Raises taxes on firms who cannot afford to buy coverage for their workers (Section 1513)
- Forces younger Americans to pay double-digit premium increases so that older workers can pay slightly less (Section 1201)
- Prohibits states from modifying their Medicaid programs to include things like modest anti-fraud protections (Section 2001)
- Includes a special provision increasing federal payments just for Tennessee (Section 1203(b))
- Allows individuals to purchase health insurance across state lines – but only if politicians and bureaucrats agree to allow citizens this privilege (Section 1333)
- Allows the HHS Secretary and federal bureaucrats to grant waivers exempting people from Obamacare’s onerous mandates, over half of which have gone to members of union plans (Section 1001)
- Creates a pseudo-government-run plan overseen by the federal government (Section 1334)
- Removes a demonstration project designed to force government-run Medicare to compete on a level playing field with private plans (Section 1102(f))
- Gives the Secretary of HHS an UNLIMITED amount of federal funds to spend funding state insurance Exchanges (Section 1311(a))
- Creates a grant program that could be used by liberal groups like ACORN or AARP to conduct “public education activities” surrounding Obamacare (Section 1311(i))
- Applies new federal mandates to pre-Obamacare insurance policies, thus proving that you CAN’T keep the insurance plan you had – and liked – before the law passed (Sections 2301 and 10103)
- Prohibits individuals harmed by federal bureaucrats from challenging those decisions, either in court or through regulatory processes (Sections 3001, 3003, 3007, 3008, 3021, 3022, 3025, 3133, 3403, 5501, 6001, and 6401)
- Earmarks $100 million for “construction of a health care facility,” a “sweetheart deal” inserted by a Democrat Senator trying to win re-election (Section 10502)
- Puts yet another Medicaid unfunded mandate on states, by raising payments to primary care physicians, but only for two years, forcing states to come up with another method of funding this unsustainable promise when federal funding expires (Section 1202)
- Imposes price controls that have had the effect of costing jobs in the short time since they were first implemented (Section 1001)
- Prohibits individuals from spending federal insurance subsidies outside government-approved Exchanges (Section 1401(a))
- Provides a special increase in federal hospital payments just for Hawaii (Section 10201(e)(1))
- Imposes new reporting requirements that will cost businesses millions of dollars, and affect thousands of restaurants and other establishments across the country (Section 4205)
- Codifies 159 new boards, bureaucracies, and programs
The Supreme Court may have struck some of these onerous provisions, but the only way to ensure that ALL these provisions are eliminated – and never return – is to repeal ALL of this unconstitutional law immediately.
In his brief remarks a few minutes ago, President Obama claimed that this morning’s Supreme Court ruling upheld Obamacare as constitutional. This statement is demonstrably incorrect. Chief Justice Roberts’ opinion is quite clear on that front; see page 58: “The Affordable Care Act is constitutional in part and unconstitutional in part.” See also page 56: “We determine…that §1396c is unconstitutional when applied to withdraw [sic] existing Medicaid funds from States that decline to comply with the expansion.”
According to the Medicare actuary, more than half of the law’s coverage expansions come not from the insurance Exchanges, but from the Medicaid expansion. The Court ruled that the states “must have a genuine choice” whether or not to implement this massive and costly expansion, rather than being subjected to what the Chief Justice called “economic dragooning that leaves the states with no real option but to acquiesce in the Medicaid expansion.” So thanks to the Court, the states will now be granted a true choice whether – in a time of significant budget stresses for many of them – they will go ahead and implement an unconstitutional law.
We’re still wading through the opinions (and given his incorrect statements this afternoon, we’d advise President Obama to do the same), but it’s clear that Obamacare WAS ruled unconstitutional. It’s also clear that more than half of the law’s coverage expansions have been thrown into doubt – because Obamacare’s coercive attempts to “dragoon” the states have been limited by the Supreme Court. And no amount of spin by the President can attempt to mask the negative implications of the Court’s decision on his unconstitutional law.
The venerable Lyle Denniston from the website SCOTUSblog reports that the Supreme Court has upheld the individual mandate as a tax – and that the Medicaid expansion was “limited but not invalidated,” as “the federal government’s power to terminate states’ Medicaid funds is narrowly read.” The ruling can be found online here (loading times are VERY slow).
We will of course provide further updates and analysis as soon as possible. However, the rulings and opinions are lengthy and will take time to digest, so please bear that in mind – patience is appreciated!
Speaking on the Senate floor during leader time this afternoon, Majority Leader Reid offered comments on this morning’s Supreme Court decision regarding Arizona’s immigration law. Sen. Reid called it “disturbing” that anyone would consider the Arizona law a policy model. He continued:
Anyone who thinks such an unconstitutional law should serve as a model, their national reform is clearly outside the mainstream and the United States Supreme Court agreed with that today.
So on Monday of this week, Sen. Reid said that an immigration bill ruled unconstitutional by the Supreme Court is “clearly outside the mainstream” and not a model for national reform. Of course, we know Sen. Reid will apply exactly the same standard to the health care bill as well. That’s why, should the Court decide to strike down some or all of Obamacare on Thursday, we eagerly await Sen. Reid’s remarks admitting that the bill he and his Democrat colleagues rammed through two years ago is “clearly outside the mainstream,” not a model for national reform, and should be repealed in its entirety for those reasons.
Two articles today touch on various aspects of the Supreme Court’s impending ruling on the constitutionality of the individual mandate. First, writing in Bloomberg View, former Obama Administration budget director Peter Orszag makes the case for the next government mandate – this one involving compulsory voting. He outlines the policy case for such a change, and then makes an important concession: “Moving to compulsory voting would probably require a constitutional change…” Over and above the obvious policy implications, Orszag’s statement presents a constitutional conundrum: Why do liberals like him believe mandatory voting requires a constitutional amendment, but mandatory health insurance does not?
Separately, the Wall Street Journal has a story anticipating fallout from the Supreme Court ruling, which includes analysis of how both parties may react:
In the Senate, senior Democrats plan to put the onus on Republicans to make the next move if the court kills the law, since they are the ones who backed the court cases against it. “You break it, you buy it,” said one Democratic leadership aide.
In other words, the party that rammed through a 2700-page bill “real fast” on a straight party line vote, using unprecedented tactics, which neither the Speaker of the House, nor the House Judiciary Committee Chairman, nor the Senate Finance Committee Chairman had bothered to read, and which took constitutional questions as not being “serious” wants to blame REPUBLICANS should the Court strike down this monumental act of legislative hubris? Good luck with that.
While the health care system prior to Obamacare was certainly flawed, it was Democrats’ law itself that broke it, with massive new mandates, regulations, and tax increases. In other words, Democrats now own all of the health care system. And regardless of how the Supreme Court rules, Democrats will own that outcome too.
The liberal advocacy group Families USA is out with a “study” today purporting to tally the number of individuals who died due to a lack of health coverage from 2005 to 2010. Today’s report extrapolates from a 2002 Institute of Medicine study that claimed about 18,000 individuals died due to lack of health insurance.
There’s just one problem with the IOM study – it has since been challenged and repudiated as inaccurate. A 2009 paper by Richard Kronick – himself a former Clinton Administration official – included the following conclusions:
Adjusted for demographic, health status, and health behavior characteristics, the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance at baseline….The Institute of Medicine’s estimate that lack of insurance leads to 18,000 excess deaths each year is almost certainly incorrect…There is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States.
And it’s not just Kronick who agrees with this analysis. Here’s Brookings Institution scholar, and noted liberal, Henry Aaron, in an interview with Politifact on the links (if any) between the uninsured and death totals:
“I found his reasoning compelling,” said Aaron, himself a member of the Institute of Medicine. “In fact, after listening to his presentation, I had a hard time believing that the IOM had done what they had done.” In interviews, Aaron and other health care scholars agreed with Kronick that uninsured and insured Americans differ in many ways other than their insurance status. “To estimate the impact of the lack of insurance on mortality rates, one has to control statistically for all of those differences,” Aaron said. That, he added, is exactly what Kronick has sought to do so.
So an intellectually rigorous analysis by one Democrat – supported as being compelling and thoughtful by other Democrats – gets ignored by a partisan liberal interest group, because it would take away their likely pre-determined conclusion that Obamacare will reduce death rates. As The Gipper himself stated, there they go again…
The Washington Post reports today on major changes underway involving college student health plans, and the punchline is one students may find to be no laughing matter – premiums will go up significantly:
College health plans…are also expected to become more costly as they accommodate the benefit requirements of the health law. A few schools have had their prices rise so much that they have decided to drop their health plans altogether….Many plans that provide limited coverage are raising their premiums as much as 50 percent to comply with the new law’s requirements for coverage, according to Stephen Beckley, a student insurance consultant and co-organizer of the Lookout Mountain Group, an organization of college health professionals.
Obamacare supporters would argue that those higher premiums are a good thing, because students are getting richer health coverage. But candidate Obama didn’t promise higher premiums and “better” coverage. He said repeatedly that premiums would go DOWN by $2,500 per family under his plan, and that “you will not have to change plans. For those who have insurance now, nothing will change under the Obama plan – except that you will pay less.”
Today’s report once again illustrates how Obamacare is failing to deliver on candidate Obama’s promises – and no amount of retrospective spin by Obamacare apologists will mask that fact.