The Hill reports this afternoon that several major pharmacies “will promote [Obamacare]…to seniors,” providing brochures about all the law’s supposed new benefits. In a conference call announcing the program, CMS Acting Administrator Marilyn Tavenner refused to give a straight answer to the question about whether the pharmacies came up with the idea for the program, or the Administration proposed it – strongly suggesting that the Obama Administration proposed this idea to pharmacies as yet another propaganda effort to win support for their unpopular law.
One unanswered question remains: Will these pharmacies also educate seniors about the law’s cuts to Medicare Advantage – which will cut enrollment in Medicare Advantage in half and reduce plan choices by two-thirds? Or does the Administration’s call for seniors to be able to “make informed healthcare decisions” only apply to the information the Administration wants seniors to see?
It’s perhaps not surprising that pharmacies would look to advertise Big Pharma’s “rock-solid deal” struck behind closed doors with President Obama – after all, pharmacies have the same financial incentives to sell more brand-name prescriptions that Big Pharma companies do. However, the more than 17 million seniors participating in Medicare Part D who are facing higher premiums thanks to this “rock-solid deal” may not be so happy.
Various press reports indicate that the Administration and liberals are “celebrating” two provisions of Obamacare taking effect today – the law’s medical loss ratio rebates, and the mandate forcing religious employers to violate their consciences and provide contraception coverage. There’s only one catch: These two provisions are inherently contradictory.
The Washington Post this morning notes that the contraception employers will be forced to cover does not come without a cost:
Contraceptives won’t cost patients, but that doesn’t make them free. Pharmaceutical companies are not handing contraceptives out to doctors offices’ without sending insurance companies a bill, too. Health plans ultimately end up paying the cost for any increased use of contraceptives. The [pro-choice] Guttmacher Institute estimated in a 1998 paper that adding contraceptive coverage would cost $21.40 per person per year in extra health insurance spending.
These statements explain why the Administration’s “accommodation” to religious employers – forcing insurers to pay for contraception themselves – was a meaningless shell game. After all, if the supposedly “greedy” insurance companies thought “free” contraception would actually lower their health costs and raise their profits, why haven’t insurers been giving patients “free” contraception all along?
At the same time the Administration is celebrating medical loss ratio rebates that it claims will lower premiums, the Administration’s new benefit mandates are raising premiums. It doesn’t make much sense to highlight insurers issuing $1.51 rebate checks if another mandate also taking effect today will cost more than 14 times that amount (i.e., $21.40 per year).
So today’s celebrations by HHS and Congressional Democrats are inherently illogical. Then again, given what the American people think about Obamacare, practically any celebration of the massive 2700-page measure would be illogical to start with.
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.
The Los Angeles Times reports today on the status of ad wars regarding the unpopular health care law – an article which includes this striking passage:
The lack of advertising in support of the bill is made even more prevalent by the fact that the Department of Health and Human Services accounts for 60% of pro-healthcare reform spending. With $46 million split among national campaigns ($29 million), cable ($14 million) and smaller buys in urban areas ($3 million), that leaves a mere $30 million spent over 3 1/2 years by every other pro-healthcare reform group nationwide.
Apparently, when this Administration complains about “corporate interests” in politics, their “solution” involves using taxpayer dollars to engage in advertising campaigns promoting a law the American people don’t want.
As a reminder, here are just some of the other wasteful projects HHS has used taxpayer dollars to fund:
- $20 million to a PR firm for a publicity campaign promoting Obamacare’s benefits
- $26 million in grants to Ogilvy Public Relations included in the “stimulus” to establish a “Publicity Center”
- $18 million to send a mailing to seniors purportedly touting the “benefits” of Obamacare to seniors. The Government Accountability Office found that the mailer – which was NOT reviewed or approved by the non-partisan Medicare actuary for its accuracy – “overstates some of [the law’s] benefits” and “presents a picture of [the law] that is not universally shared.”
- $3 million in taxpayer funds to run an ad campaign in which Andy Griffith took on the role of “pitching President Barack Obama’s health care law to seniors.” The non-partisan factcheck.org concluded that the ads used “weasel words” to mislead seniors about the impact of the health care law.
- Millions more in taxpayer funds to fund 4 million postcards promoting Obamacare’s small business tax credit – which the Government Accountability Office recently concluded was convoluted and ineffective.
With spending projects like these, is it any wonder that the federal government is running trillion-dollar deficits?
The staffing company Jackson Healthcare is out with a new survey testing physician attitudes towards Obamacare, and the results are not encouraging for the law. Only 31% of physicians give the law an “A” or “B” grade – and the mean average grade for the law was a “D.”
Other findings from a majority of doctors in the survey:
- The law will not control costs (70%);
- The law will not improve the doctor-patient relationship (67%);
- The law will take away physicians’ control over their practices (66%);
- The law will not improve health care quality (61%); and
- Congress should repeal the law and start over (55%).
That last point is perhaps the most salient: A majority of physicians in this survey believe Obamacare should be repealed, and Congress should start over with step-by-step, common-sense reforms to lower health costs – a sentiment, and an action plan, many Americans fervently hope will come to fruition.
Writing in the New Yorker, author Ryan Lizza’s latest article examines what a re-elected Barack Obama might attempt to accomplish in a second term as President. The piece discusses immigration, fiscal policy, and energy, but also includes an interesting passage on health care, and how the Administration might respond should the Supreme Court strike down Obamacare’s individual mandate, but leave the rest of the law in place:
Obama would face a choice: replace the mandate with a new policy or remove the remaining market reforms. One option for replacing the mandate is to push the uninsured into the new system by requiring them to sign up for insurance when applying for other government services, such as food stamps or school loans. But the prospects for this sort of legislation are bleak. “We looked at this,” a former Obama aide said. “We thought it was less constitutional than the mandate. Among the moderate Democrats, the idea that you would pass a bill like this is unimaginable.”
Whether the Supreme Court overturns the law in part or in full, the White House will need to respond publicly. “The strategy is to just go on the offensive and say, ‘Look at Citizens United, look at the health-care decision, look at Bush v. Gore,” the former aide said. “We have an out-of-control activist court….That’s Plan A. Plan B is nothing.”
This passage includes two incredible statements. First, the Obama Administration has examined the idea of forcing individuals to prove they purchased government-approved health insurance every time they interact with public officials – a step not far removed from a “Show Me Your Papers” requirement on every American citizen. The fact that the former Administration official quoted in the piece dismissed such a policy largely on grounds of political expediency – moderate Democrats in Congress would never vote to enact these requirements – speaks volumes to how far the Administration may go to compel individuals to obey its commands.
Yet the liberals who would require individuals to purchase government-approved health insurance – and use the full coercive power of the state to enforce such a requirement – are the same individuals who are prepared to criticize conservatives for “out of control activis[m]” if the Supreme Court strikes down some or all of Obamacare. Imposing an unprecedented mandate to purchase a government-defined product certainly qualifies as activism. And the Obama Administration’s idea of forcing citizens to comply with a new “Show Me Your Papers” regime to enforce government-defined health insurance is out-of-control by any reasonable definition. That’s why it’s so critical for the Supreme Court to strike down the individual mandate, and all of Obamacare – not as a measure of judicial activism, but as a way to impose constitutional restraints on an out-of-control Congress and executive.
The House Energy and Commerce Committee released its latest report into the backroom dealings behind Obamacare on Friday. This report, as well as a memo released the previous week, and the supplemental documents related to each report, provide for an interesting read, on multiple levels.
It is of course interesting to learn precisely how candidate Obama went from criticizing Big Pharma’s CEO for exerting improper influence in a 2008 campaign ad to cutting a “rock-solid deal” with the very same executive he had earlier criticized. It’s just as ironic to find a President who pledged to televise all health care negotiations on C-SPAN cutting legislative deals behind closed doors. And perhaps the piece de resistance is the way the Administration endorsed the creation of secret advocacy groups designed to run pro-Obamacare ads – the same kind of “shadow groups” that President Obama has repeatedly criticized as being insufficiently transparent.
But over and above the irony – and hypocrisy – readily apparent in these documents lies a simpler yet more profound truth: Practically every health care group in Washington SUPPORTED Obamacare, and moved heaven and earth to build public support for the law, yet the American people OPPOSED it – and still oppose it to this day. The documents reveal just how desperate special interests were to enact the massive 2700-page law:
- Big Pharma spent $69.7 million on advertising supporting the law through various coalitions – and that’s just one trade association.
- The CEO of AARP personally called Senator Ben Nelson to solicit his support for the measure – after multiple requests from the White House.
- The heads of the major hospital associations let White House officials edit their press releases about their own “deals” with the Administration.
A separate study from Bloomberg Government released late last week demonstrated just why all these special interests were so keen on passing Obamacare. The study found that a Supreme Court decision striking down the law could cost pharmaceutical companies, hospitals, and other health care interests as much as $740 billion in revenue over the next ten years. Hospitals alone could lose $430 billion. Coming on the heels of last month’s study indicating insurers benefit from Obamacare to the tune of $1 trillion, the Bloomberg report illustrates perfectly why all the health care special interests were desperate to pass the law – as the Energy and Commerce documents reveal.
As might be expected, the documents also include some comedic moments. Given that experts have concluded that Obamacare will make 40 percent of hospitals unprofitable, the frantic struggle among hospital association executives to get Democrat members to vote for the bill may be (to paraphrase an historic expression) the first time in recorded history that turkeys desperately lobbied Congress to vote for Thanksgiving. In a moment of candor, one Pharma executive – a Democrat and former Clinton Administration official – after telling his colleague the bill “raises taxes, raises [insurance] premiums and cuts Medicare,” admitted that “I’ve seen them [i.e., Pharma’s campaign ads about Obamacare]. But I don’t believe them.”
He’s not the only one who didn’t believe the ads. The American people didn’t believe the hype about Obamacare then, and they don’t believe it now. And no amount of special interest lobbying, or “rock-solid deals,” can change that fact.
Politico reports that, when asked at her weekly press conference this morning about new polling data indicating more than two-thirds of Americans want at least some of Obamacare struck down, former House Speaker Nancy Pelosi said Obamacare “is about life, liberty, and the pursuit of happiness for the American people.” Politico further reported that Pelosi said the law would allow people to leave their jobs “to pursue their happiness” without fear of losing insurance.
Her comments this morning echo Pelosi’s 2010 remarks about Obamacare, in which she encouraged artists to “leave your work” and “be creative and be a musician or whatever” because they will have government-funded health coverage under the law. Of course, this message is slightly inconsistent with her other claims that Obamacare will create 4 million new jobs. And there’s also the minor detail that in order for Americans to reclaim their “pursuit of happiness” to quit their jobs, as Pelosi claimed, they actually need to have a job to quit. By Pelosi’s logic (such as it is), the “stimulus” must have also promoted liberty – it hasn’t delivered the jobs promised, so millions of Americans have been engaged in the “pursuit of happiness” on the unemployment lines.
More fundamentally, however, is this principle many conservatives believe: Liberty comes neither from government mandates and diktats, nor from government programs encouraging a culture of dependence – it comes from government creating an environment where each individual has the freedom to govern his or her own life. Obamacare includes an unprecedented mandate for individuals to purchase a government-defined product, and trillions of dollars in new spending on unsustainable entitlements that non-partisan experts agree will discourage work and harm economic growth. Both elements are fundamentally antithetical to liberty – which is why ALL of Obamacare must be repealed.
Bloomberg reported last night that the White House is preparing its liberal backers to begin planning for yet another debate about health care, this one potentially to take place in a second Obama term:
President Barack Obama is confiding to Democratic donors that he may have to revisit the health-care issue in a second term, a position at odds with his publicly expressed confidence that the U.S. Supreme Court will uphold [Obamacare], according to three Democratic activists….As he previewed his agenda for donors at a May 14 fundraiser, Obama said he may be forced to try to revise parts of his health-care plan, depending on how the court rules later this month, said one activist, who requested anonymity to discuss the president’s comments….The president has made similar remarks, usually in response to questions, at other fundraising events since the Supreme Court heard arguments in the case….Obama’s answers, which begin with the president repeating his contention that the high court will uphold the law, have led some contributors to conclude the White House is making contingency plans should the justices strike down parts of the law, which would give Republicans a powerful talking point about one of his signature issues.
It’s worth noting that, when addressing Congress on health care in September 2009, Obama proudly stated: “I am not the first President to take up this cause, but I am determined to be the last.” Perhaps that statement was made before the President and his Democrat colleagues got “serious” about the Constitution, and discovered that it would be an unprecedented step for Congress to require all Americans to purchase a product for the first time ever. It’s nice that these liberals are finally coming to grips with the prospect of limited constitutional government – but it might have been better to do so BEFORE ramming through a massive 2700-page law that the American people didn’t want (and still don’t either).
Regardless, the President has already given his liberal base fair warning that Obamacare will be a topic for discussion in a second Obama term. I’m sure the White House will be sending out invitations to the C-SPAN cameras in no time at all…
Last week, the liberal messaging group Herndon Alliance released a series of talking points and poll results that are intended to make Obamacare more palatable (or perhaps less un-palatable) to voters. The full memo can be found here, but it’s interesting to highlight some of the arguments and spin that supporters of the law are resorting to in an attempt to generate public support:
- Medicare: The memo encourages liberals to claim the law “cuts waste from Medicare.” Above and beyond Nancy Pelosi’s stunning admission last year that Democrats “took a half a trillion dollars out of Medicare in [Obamacare], the health care bill” to pay for more federal spending, the fact remains that, according to the non-partisan Medicare actuary, the law will cause 40 percent of hospitals and medical providers to become unprofitable in the long term. Do liberals really want to claim that driving up to 40 percent of all medical providers out of business constitutes cutting “waste?”
- Federal Spending: The memo notes that “it wasn’t the individual mandate or higher premiums that raised the most concern, but rather that the law would burden taxpayers and the nation’s budget with another trillion dollars of government spending.” Unfortunately for the law’s supporters, in reality Obamacare doesn’t spend just $1 trillion; it spends $2.5 trillion in its first ten years alone. And even Democrats have admitted as much.
- Giveaways to Insurers: The memo claims that the law “holds insurance companies accountable,” and that “opponents of the law are siding with the insurance companies that donate to their campaigns. Some may find this claim a bit rich – $1 trillion rich, in fact – since a Bloomberg study released last week found that insurers stand to gain $1 trillion in new revenue thanks to Obamacare.
- Ending Medicare: The memo attempts to inoculate the law from attacks by claiming that Republicans would “end Medicare as we know it.” In reality, Medicare is ending Medicare as we know it; the President’s then-Chief of Staff, Bill Daley, said in July that Medicare “will run out of money in five years if we don’t do something.” And it’s Obamacare that created a new board of unelected and unaccountable bureaucrats empowered to make binding rulings on how to reduce Medicare spending.
- IPAB: The memo attempts to frame the law’s Independent Payment Advisory Board – 15 bureaucrats given the reins over Medicare spending – as a “taxpayer protection board.” Well, if that’s the case, why hasn’t President Obama nominated anyone to the IPAB – does he not want to protect taxpayers? What is the Administration trying to hide during the President’s re-election campaign?
- Tax Credits: The memo claims that “the law will give small businesses more control by giving them tax credits to help them purchase insurance.” But that’s not what the non-partisan Government Accountability Office concluded just this week – it said Obamacare was giving small businesses bureaucratic headaches, because the tax credits were so paltry and difficult to claim that most firms decided it wasn’t worth the hassle.
- Members of Congress: The memo claims that the law “requires that Members of Congress get their health care coverage from the same plans as millions of Americans.” But according to the Medicare actuary, most of the growth in insurance coverage under the law will come from an expansion of Medicaid. And that program is so bad that not a single Democrat voted to place themselves in Medicaid when given an opportunity to do so back in 2010.
That said, the memo does include a few gems of candor. It admits that “most polling shows that voters are much more likely to believe that [Obamacare] will increase healthcare costs rather than lower them.” (File that under “No Kidding.”) And then there’s this paragraph on the individual mandate:
Although the individual mandate is certainly opposed by voters, our research shows that it is less of a concern to them than other aspects of the law, such as the trillion dollar price tag, the potential for higher premiums and the cuts to Medicare. That said, the individual mandate was the one aspect of [Obamacare] where none of our responses outperformed the attack. While the mandate may not be driving concern over the [law], voters clearly have a hard time being persuaded of its merits.
As we’ve previously noted, some may find these continued attempts to muster enthusiasm for an unpopular law an exercise in futility. The fact that supporters of the law have been forced to rely on stale arguments so easily rebutted demonstrates that it’s not the messaging that’s the problem with Obamacare – it’s the law the left is trying to message.