Will the Trump Administration Help Republicans Expand Obamacare?

For all the allegations by the Left about how the Trump administration is “sabotaging” Obamacare, a recent New York Times article revealed nothing of the sort. Instead it indicated how many senior officials within the administration want to entrench Obamacare, helping states to expand the reach of one of its costly entitlements.

Thankfully, a furious internal battle took the idea off the table—for now. But instead of trying to find ways to increase the reach of Obamacare’s Medicaid expansion, which prioritizes able-bodied adults over individuals with disabilities, the Trump administration should instead pursue policies that slow the push towards expansion, by making the tough fiscal choices surrounding expansion plain for states to see.

What ‘Partial Expansion’ Means

Following the court’s decision, the Obama administration determined expansion an “all-or-nothing” proposition. If states wanted to receive the enhanced match rate for the expansion—which started at 100 percent in 2014, and is slowly falling to 90 percent for 2020 and future years—they must expand to all individuals below the 138 percent of poverty threshold.

However, some states wish to expand Medicaid only for adults with incomes below the poverty level. Whereas individuals with incomes above 100 percent of poverty qualify for premium and cost-sharing subsidies for plans on Obamacare’s exchanges, individuals with incomes below the poverty level do not. (In states that have not expanded Medicaid, individuals with incomes below poverty may fall into the so-called “coverage gap,” because they do not have enough income to qualify for subsidized exchange coverage.)

States that wish to cover only individuals with incomes below the poverty line may do so—however, under the Obama administration guidance, those states would receive only their regular federal match rate of between 50 and 74 percent, depending on a state’s income. (Wisconsin chose this option for its Medicaid program.)

How ‘Partial Expansion’ Actually Costs More Money

The Times article says several administration supporters of “partial expansion”—including Health and Human Services (HHS) Secretary Alex Azar, Centers for Medicare and Medicaid Administrator (CMS) Seema Verma, and Domestic Policy Council Director Andrew Bremberg—believe that embracing the change would help to head off full-blown expansion efforts in states like Utah. An internal HHS memo obtained by the Times claims that “HHS believes allowing partial expansion would result in significant savings over the 10-year budget window compared to full Medicaid expansion by all.”

In reality, however, “partial expansion” would explode the budget, for at least three reasons. First, it will encourage states that have not embraced expansion to do so, by lowering the fiscal barrier to expansion. While states “only” have to fund up to 10 percent of the costs of Medicaid expansion, they pay not a dime for any individuals enrolled in exchange coverage. By shifting individuals with incomes of between 100-138 percent of poverty from Medicaid to the exchanges, “partial expansion” significantly reduces the population of individuals for whom states would have to share costs. This change could encourage even ruby red states like Texas to consider Medicaid expansion.

Second, for the same reason, such a move will encourage states that have already expanded Medicaid to switch to “partial expansion”—so they can fob some of their state costs onto federal taxpayers. The Times notes that Arkansas and Massachusetts already have such waiver applications pending with CMS. Once the administration approves a single one of these waivers, virtually every state (or at minimum, every red state with a Medicaid expansion) will run to CMS’s doorstep asking for the federal government to take these costs off their hands.

Medicaid expansion has already proved unsustainable, with exploding enrollment and costs. “Partial expansion” would make that fiscal burden even worse, through a triple whammy of more states expanding, existing states offloading costs to the federal government through “partial expansion,” and the conversion of millions of enrollees from less expensive Medicaid coverage to more costly exchange plans.

What Washington Should Do Instead

Rather than embracing the fiscally irresponsible “partial expansion,” the Trump administration and Congress should instead halt another budget gimmick that states have used to fund Medicaid expansion: The provider tax scam. As of last fall, eight states had used this gimmick to fund some or all of the state portion of expansion costs. Other states have taken heed: Virginia used a provider tax to fund its Medicaid expansion earlier this year, and Gov. Paul LePage (R-ME)—who heretofore has steadfastly opposed expansion—recently floated the idea of a provider tax to fund expansion in Maine.

The provider tax functions as a scam by laundering money to generate more federal revenue. Providers—whether hospitals, nursing homes, Medicaid managed-care plans, or others—agree to an “assessment” that goes into the state’s general fund. The state uses those dollars to draw down new Medicaid matching funds from the federal government, which the state promptly sends right back to the providers.

For this reason, politicians of all parties have called on Congress to halt the provider tax gimmick. Even former vice president Joe Biden called provider taxes a “scam,” and pressed for their abolition. The final report of the bipartisan Simpson-Bowles commission called for “restricting and eventually eliminating” the “Medicaid tax gimmick.”

If Republicans in Congress really want to oppose Obamacare—the law they ran on repealing for four straight election cycles—they should start by imposing a moratorium on any new Medicaid provider taxes, whether to fund expansion or anything else. Such a move would force states to consider whether they can afford to fund their share of expansion costs—by diverting dollars from schools or transportation, for instance—rather than using a budget gimmick to avoid those tough choices. It would also save money, by stopping states from bilking the federal government out of billions in extra Medicaid funds through what amounts to a money-laundering scam.

Rhetoric vs. Reality, Take 5,000

But of course, whether Republicans actually want to dismantle Obamacare remains a very open question. Rather than opposing “partial expansion” on fiscal grounds, the Times quotes unnamed elected officials’ response:

Republican governors were generally supportive [of “partial expansion”], but they said the change must not be seen as an expansion of the Affordable Care Act and should not be announced before the midterm elections. Congressional Republican leaders, while supportive of the option, also cautioned against any high-profile public announcement before the midterm elections.

In other words, these officials want to expand and entrench Obamacare, but don’t want to be seen as expanding and entrenching Obamacare. What courage!

Just as with congressional Republicans’ desperate moves to bail out Obamacare’s exchanges earlier this year, the Times article demonstrates how a party that repeatedly ran on repealing Obamacare, once granted with the full levers of power in Washington, instead looks to reinforce it. Small wonder that the unnamed politicians in the Times article worry about conservative voters exacting a justifiable vengeance in November.

This post was originally published at The Federalist.

Dear Congress: Take My Obamacare Coverage — Please!

Last week, Vox ran a story featuring individuals covered by Obamacare, who live in fear about what the future holds for them. They included people who opened small businesses because of Obamacare’s coverage portability, and worry that the “career freedom” provided by the law will soon disappear.

Unfortunately, but perhaps unsurprisingly, Vox didn’t ask this small business owner—who also happens to be an Obamacare enrollee—for his opinions on the matter. Like the enrollees in the Vox profile, I’m also incredibly worried about what the future holds, but for a slightly different reason: I’m worried for our nation about what will happen if Obamacare ISN’T repealed.

What Obamacare Hasn’t Done For Me

While in generally decent health, I have some health concerns: mild hypertension (controlled by medications), mild asthma, and allergies that have worsened in the past few years. I’ve gone through two reconstructive surgeries on my ankle, which I’ve chronicled in a prior article. Under “research” previously published by the Obama Administration, my health conditions classify me as one of the 129 million people with a pre-existing condition supposedly benefiting from the law.

Yet while my health hasn’t changed much since Obamacare passed and was implemented, my health insurance policy has already been cancelled once. The replacement I was offered this year included a 20 percent premium increase, and a 25 percent increase in my deductible.

If Obamacare was repealed, or if insurers stopped offering coverage, it would be an inconvenience, no doubt. I don’t know what options would come afterwards. That would depend on actions by Congress, the District of Columbia, and the insurance community. But having already lost my coverage once, and gone through double-digit premium and deductible increases, how much worse can it really get?

Obamacare Will Raise the Deficit

I know what liberals are saying: “But Obamacare will reduce the deficit!” Yes, the Congressional Budget Office did issue a score saying the law will lower the deficit. But consider all the conditions that must be met for Obamacare to lower the deficit. If:

  • Annual Medicare payment reductions that will render more than half of all hospitals unprofitable within the next 10 years keep going into effect; and
  • Provisions that will, beginning in 2019, reduce the annual increase in Exchange insurance subsidies—making coverage that much more unaffordable for families—go into effect; and
  • An unpopular “Cadillac tax” that has already been delayed once—and which the Senate voted to repeal on a bipartisan 90-10 vote in December 2015—actually takes effect in 2020 (which just happens to be an election year); then

The Congressional Budget Office estimates that the law will reduce the deficit by a miniscule amount. But if any of those conditions aren’t met, then the law becomes a budget-buster. And if you think all those conditions will actually come to pass, then I’ve got some land to sell you.

Obamacare’s Unspoken Opportunity Costs

Even if you believe in raising taxes to reduce the deficit, Congress has already done that. Except that money wasn’t used to lower the deficit—it’s been used to pay for Obamacare. Even some liberals accept that you can only tax the rich so much, at which point they will stop working to avoid paying additional income in taxes. Obamacare brought us much closer to that point, without doing anything to put our fiscal house in order.

We Just Can’t Afford Obamacare

Whether they’re liberal websites, Democratic leaders, or Republican politicians attempting to cover as many Americans as Obamacare in their “replacement,” no one dares utter the four words that our country will soon face on any number of fronts: “We can’t afford it.”

But the fact of the matter is, we can’t afford Obamacare. Not with trillions of dollars in debt, 10,000 Baby Boomers retiring every day, and the Medicare trust fund running over $130 billion in deficits the past eight years. Our nation will be hard-pressed to avoid all its existing budgetary and financial commitments, let alone $2 trillion in spending on yet more new entitlements.

So, to paraphrase Henny Youngman, take my health coverage—please. Repeal Obamacare, even if it means I lose my health coverage (again). Focus both on reducing health costs and right-sizing our nation’s massive entitlements.

Failing to do so will ultimately turn all 300-plus million Americans into the “faces of Obamacare”—victims of a debt crisis sparked by politicians and constituents who want more government than the public wants to pay, and our nation can afford.

This post was originally published at The Federalist.

Obamacare Shocker: Premiums Could Double

This morning’s Wall Street Journal published its own analysis of premiums under Obamacare, and its conclusions will prompt shock—rate shock—among those who need to buy health insurance under the law’s new exchanges next year:

Healthy consumers could see insurance rates double or even triple when they look for individual coverage under the federal health law later this year, while the premiums paid by sicker people are set to become more affordable, according to a Wall Street Journal analysis of coverage to be sold on the law’s new exchanges. The exchanges, the centerpiece of President Barack Obama’s health-care law, look likely to offer few if any of the cut-rate policies that healthy people can now buy, according to the Journal’s analysis.

The article goes on to provide specific examples of the kind of premium hikes many Americans may face under Obamacare:

Virginia is one of the eight states examined by the Journal and offers a fairly typical picture. In Richmond, a 40-year-old male nonsmoker logging on to the eHealthInsurance comparison-shopping website today would see a plan that costs $63 a month from Anthem, a unit of WellPoint Inc. That plan has a $5,000 deductible and covers half of medical costs.

By comparison, the least-expensive plan on the exchange for a 40-year-old nonsmoker in Richmond, also from Anthem, will likely cost $193 a month, according to filings submitted by carriers.

Liberals may argue that even though premiums may triple for some Americans, these individuals will be getting “better” insurance. But that’s not what then-Senator Obama promised—he said premiums would go down under his plan by $2,500 per family per year. Moreover, the Congressional Budget Office noted in 2009, well before the law passed, that premiums would go up in part because Obamacare forces individuals to buy more costly health insurance policies:

Average premiums would be 27 percent to 30 percent higher because a greater amount of coverage would be obtained. In particular, the average insurance policy in this market [i.e., on exchanges] would cover a substantially larger share of enrollees’ costs for health care (on average) and a slightly wider range of benefits. Those expansions would reflect both the minimum level of coverage (and related requirements) specified in the proposal and people’s decisions to purchase more extensive coverage in response to the structure of subsidies.

Liberals’ response to the latest analysis of higher premiums is particularly telling. From the WSJ:

Tom Perriello, who voted for the law as a Democratic House member from Virginia and who now works for the left-leaning Center for American Progress, called the costs of premiums “a work in progress” and added, “Over the next few years, we should see that cost curve bend.”

In other words, premiums won’t go down any time soon. That admission from a lawmaker who helped ram Obamacare into law will likely prove cold comfort to millions of Americans facing higher premiums due to the measure next year.

This post was originally published at The Daily Signal.

How You CAN’T Keep Your Current Coverage

In case you hadn’t seen it, the Galen Institute yesterday released a new paper discussing the havoc Obamacare is wreaking on insurance markets, and specifically the insurance many Americans had – and liked – before the massive 2700 page law was passed.  The paper includes the most comprehensive collection I have seen of anecdotes regarding insurance carriers who have dropped out of some markets, or gotten out of the health insurance industry completely, since Obamacare passed.  Below are the relevant excerpts from the Galen paper that tell the tale of Obamacare’s woes (I’ve edited the below lightly for length and by replacing citations with hyperlinks).  The complete list of companies that have dropped out of the insurance market shows the breathtaking scope of the impact this massive reorganization of health care is having on Americans’ lives.

Three years ago, candidate Obama promised 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.”  And President Obama followed with the same pledge: “If you like your doctor, you will be able to keep your doctor.  Period.  If you like your health care plan, you will be able to keep your health care plan.  Period.  No one will take it away.  No matter what.”  The Galen report once again illustrates how hollow those pledges have proved.

 

The American Enterprise Group announced in October 2011 that it would stop offering non-group health insurance in more than 20 states.  As a result, 35,000 people will lose the health coverage they have now.  The company cited regulatory burdens, including the “medical loss ratio” (MLR) requirements (see page 4 for more), in explaining its decision to leave the markets.  This means there will be less competition in these 20 states, resulting in higher prices for consumers in many cases.

In New York, Empire BlueCross BlueShield said it will drop in the spring of 2012 health insurance plans covering about 20,000 businesses in the state. Mark Wagar, president and CEO of Empire, said that the company will eliminate seven of the 13 group plans it currently offers to businesses which have two to 50 employees.  The move is expected to have a great and potentially “catastrophic” impact on small businesses in New York, according to James L. Newhouse, president of Newhouse Financial and Insurance Brokers in Rye Brook, NY.  This loss of competition inevitably will lead to higher prices and fewer choices for businesses and their employees.

In Colorado, World Insurance Company/American Republic Insurance Company announced in October 2011 that it is leaving the individual market, citing the company’s inability to comply with insurance regulations.

In Indiana, nearly 10 percent of the state’s health insurance carriers have withdrawn from the market because they are unable to comply with the federal medical loss ratio requirement.  Indiana was hoping to bring the companies back by asking the Department of Health and Human Services (HHS) for a waiver from the rule, but Washington refused in late November 2011 to grant the waiver….

These are the latest in a series of announcements that health insurers are leaving the market as a result of ObamaCare’s edicts.  But there are many more.

The exodus continues

Citizens in states around the country have learned that carriers are leaving markets, largely as a consequence of the combined effect of the health law and state regulations that make it particularly difficult to offer coverage in the small group market.

Principal Financial Group, based in Iowa, announced in 2010 that it would stop selling health insurance, impacting 840,000 people who receive their insurance through employers served by the company.  The company assessed its ability to compete in the new environment created by PPACA and concluded its best course was to stop selling health insurance policies.

Another 42,000 employees of small and midsize employers learned in January 2011 they were losing their health coverage with Guardian Life Insurance Co. of America. The company announced it was leaving the group medical insurance market (it had reached an agreement with UnitedHealthcare to renew coverage for Guardian clients).  Guardian began withdrawing from the medical insurance market in specific states more than a decade ago, and says it would be leaving the market with or without PPACA.

Cigna announced that it is no longer offering health insurance coverage to small businesses in 16 states and the District of Columbia: California, Connecticut, Florida, Georgia, Hawaii, Illinois, Kansas, Missouri, New Hampshire, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Texas, Virginia, and Washington, D.C.

In Colorado, Aetna will stop selling new health insurance to small groups in the state and is moving existing clients off its plans this year, affecting 1,200 companies and 5,200 employees and their dependents.   Aetna also has pulled out of Colorado’s individual market because of concerns about its ability to compete there, dropping 22,000 members.  Aetna also has dropped out of the small-group market in Michigan and several other states.

Since June of 2010, 13 plans have left the health insurance market in Iowa, citing regulatory concerns.

In New Mexico, four insurersNational Health Insurance, Aetna, John Alden, and Principal — are no longer offering insurance to individuals or to small businesses — drying up the market and driving out competition.

In Utah, Humana is ending its participation in the Utah Health Exchange, leaving only three carriers participating in the exchange.

In Virginia, UniCare has eliminated its individual market coverage for about 3,000 policyholders.  And shortly after the health law was enacted in

2010, a new Virginia-based company, nHealth, announced it was closing its doors, saying that the regulatory burdens posed by the health law made it impossible to gain investor support to continue operating.

More Administration Flip-Flopping on Taxes and the Individual Mandate

Testifying before the Ways and Means Committee, CEA Chairman Austan Goolsbee just rejected the idea that the individual mandate was a tax increase on the middle class.  That may come as a surprise to many within the Administration, as the Justice Department is defending the mandate as a tax increase, even though President Obama in September 2009 made comments “absolutely” rejecting the mandate as a tax increase.  The Administration’s constant reversals on this issue have drawn attention from the courts as well, as a judge in Virginia asked the Justice Department whether the President was “trying to deceive the people” by claiming the mandate wasn’t a tax increase in 2009, only to assert in the courts that the mandate is a constitutional tax after the law was passed.

Mr. Goolsbee also made the argument that the other provisions in the health care law – such as the new Flexible Spending Account restrictions – don’t in reality violate the President’s promise because they “aren’t in the normal form” for tax increases.  He also claimed that “the totality of” the law means individuals will benefit, because health costs will do down.  However, the non-partisan Medicare actuary found that costs will INCREASE by more than $310 billion as a result of the measure – meaning Mr. Goolsbee’s stated rationale for defending the tax increases doesn’t hold water.

And in case you’re curious, the full list of tax increases under the law – including those that apply to individuals with incomes under $250,000 – is available here.

Obama’s Mandate Flip-Flop

Following Monday’s ruling in Virginia striking down the health care law’s individual mandate, the Washington Post reports this morning that the ruling means “President Obama has landed in the position of defender-in-chief of an idea he once opposed.”  The article points out that the individual mandate is one of the most unpopular provisions of the health care law, and that “over and over, [Obama] said on the campaign trail that such a mandate was unnecessary.”

There are many Obama campaign quotes on the individual mandate, but my favorite – and perhaps the most telling one – is this: “If a mandate was a solution, we could try that to solve homelessness by mandating everyone buy a house.”

Obama’s U-turn on an individual mandate to purchase health insurance raises the following question:  If the President reversed himself on forcing people to buy insurance, and liberals are arguing that Congress has the power to force individuals to engage in activity (even to eat three vegetables a day), who can argue that this Administration – or any future Administration – will not take the position that candidate Obama so derided, and attempt to “solve homelessness by mandating everyone buy a house?”

Follow-Up from Virginia Health Care Ruling

As might be expected, there are numerous articles this morning following up on Judge Hudson’s ruling in the Virginia case against the health care law.  Secretaries Holder and Sebelius have an op-ed in the Washington Post arguing that “striking down the individual responsibility provision means slamming the door on millions of Americans like Gail O’Brien, who’ve been locked out of our health insurance markets” – emotional arguments which some may view as tangential (at best) to the core legal issue of whether the Constitution permits the federal government to force every American to buy a particular product.  Other interesting points of note from this morning’s stories:

  • The Brookings Institution’s Henry Aaron told a Bloomberg reporter that striking down the mandate would lead to MORE federal spending: “The only way this works is if they offer an adequate subsidy and it’s debatable whether the law currently does that.”  Some would question the premise that the “solution” to striking down a law due to Congressional overreach is yet more government spending.
  • In the same Bloomberg piece, the liberal Aaron admitted that the law’s constitutionality is “well short of a certainty,” demonstrating that even the left is being forced to consider constitutional questions that Speaker Pelosi herself didn’t think serious earlier this year.
  • Georgetown law professor Randy Barnett was quoted in the New York Times: “All the insiders thought [the law’s constitutionality] was a slam dunk…Maybe a slam dunk like weapons of mass destruction were a slam dunk.”
  • Speaking to Politico, George Washington University law professor Jonathan Turley called Monday’s ruling “very thoughtful—not a screed…I don’t see any evidence this is motivated by Judge Hudson’s personal beliefs….Anybody who’s dismissing this opinion as a political screed has obviously not read the opinion.”

There were additional stories from the Wall Street Journal and the Washington Post.  In addition to its legal analysis above, the New York Times had several pieces – a general overview, a story on how the ruling will affect implementation, and an editorial that (shockingly) supports the law. But perhaps most interesting of all is the Times’ piece on the political impact, which notes that “from a political standpoint, the only case [against the health care law that really matters is the one Mr. Obama lost on Monday,” and argues that “the ruling puts Mr. Obama on the defensive over health care at a time when he would rather be talking about the economy” and that the President “has been unable to bring the public to his side” on the issue.  (On a related note, yesterday’s ABC News poll found that 52 percent disapprove of the health care law, while only 43 percent support it, the largest gap in support “since the latest debate over health care reform began in earnest in summer 2009.”)

Democrats’ Taxing Two-Step

The New York Times published an editorial yesterday defending the constitutionality of the individual mandate.  Of particular note was a passage regarding whether or not the mandate constitutes a tax.  Despite claims by President Obama absolutely rejecting the notion that the mandate was a tax, the Times believes “a penalty to prod people into taking out health insurance seems little different [from a tax], whatever label it is called.”  The editorial also asserted that people shouldn’t spend time “getting hung up on labels adopted in the heat of political battle.”

That last passage raises two key questions:

  1. As the federal judge in the Virginia lawsuit asked of the Justice Department, does the Times believe President Obama was “trying to deceive the people?”
  2. Does the Times believe that such deception is permissible “in the heat of political battle?”

The fact of the matter is that Judge Vinson’s ruling on the motion to dismiss in the Florida multi-state lawsuit spent about 20 pages analyzing the bill text to determine that Congress did not intend for the mandate to be a tax.  From page 16 of the ruling:

The defendants are wrong to contend that what Congress called it “doesn’t matter.”  To the extent that the label used is not just a label, but is actually indicative of legislative purpose and intent, it very much does matter.  By deliberately changing the characterization of the exaction from a “tax” to a “penalty,” but at the same time including many other “taxes” in the Act, it is manifestly clear that Congress intended it to be a penalty and not a tax.

Judge Vinson provided five different justifications for his determination that the mandate was not a tax, based on the text of the legislation; page 22 of the ruling notes that Congress:

(i)  Specifically changed the term in previous incarnations of the statute from “tax” to “penalty;”

(ii)  Used the term “tax” in describing the several other exactions provided for in the Act;

(iii)  Specifically relied on and identified its Commerce Clause power and not its taxing power;

(iv)  Eliminated traditional IRS enforcement methods for the failure to pay the “tax;” and

(v)  Failed to identify in the legislation any revenue that would be raised from it, notwithstanding that at least seventeen other revenue-generating provisions were specifically so identified.

Of late, Democrats have come to cite the taxing power as justification for the mandate’s constitutionality.  While some may welcome Democrats finally acknowledging the health care law does in fact represent a massive tax increase on the middle class, a retrospective attempt to re-frame the law that was passed will not resolve the significant questions about its constitutionality.

Six Months Later…

As expected, there’s quite a bit of media coverage this morning of the September 23 festivities marking six months since the health care bill was signed into law.  A couple of key points to keep in mind:

  • In his town hall meeting in Virginia yesterday, the President claimed that “We feel pretty confident that over the long term…premiums are going to be lower than they would be otherwise, health care costs are going to be lower than they would be otherwise.”  That’s not however what the experts have claimed – the Congressional Budget Office confirmed that individual market premiums will go up by an average $2,100 per family more than they would have had the law not passed, and the Administration’s own actuary found that health costs will rise by an extra $310,800,000,000 over the next ten years as a result of the law.
  • While the President said yesterday his health care bill would reduce premiums “over the long term,” he promised immediate relief to struggling families during his presidential campaign.  Here’s what campaign advisor Jason Furman – one of the candidates to replace Larry Summers as the head of the President’s National Economic Council – said in July 2008: “We think we could get to $2,500 in savings by the end of the first term, or be very close to it.”
  • All the benefits being promoted today may be helpful or worthwhile to some – but because they are passed along to all consumers in the form of higher premium costs, everyone will pay for the benefits, regardless of whether or not individuals need, or want, that coverage.  And they are fundamentally inconsistent with the President’s promises – on the campaign and elsewhere – that the law will reduce health costs and lower premiums by $2,500 per family.  The Heritage Foundation has a great new one-pager providing a “Dirty Dozen” list of reasons why the health care law will raise premiums – it’s worth a look.
  • The President was quoted yesterday as saying Republicans should “look you in the eye” and tell a woman with Hodgkin’s disease that she shouldn’t have insurance.  This statement amounts to pure rhetoric on the President’s part, for Republicans have consistently supported high-risk pools for individuals with pre-existing conditions.  In fact, the House Republican health care alternative provided MORE funding for high-risk pools than the health care law itself—and didn’t require individuals with pre-existing conditions to go without insurance for six months before becoming eligible for coverage, as the health care law does.
  • Conversely, John Goodman writes in this morning’s Wall Street Journal about how enrollment in Medicare Advantage will fall by a projected 7.4 million seniors, according to the Medicare actuary, and how seniors will lose billions of dollars in Medicare Advantage benefits, as outlined in a Heritage Foundation study released last week.  Will the President look those seniors in the eye and tell them why they should be forced off their current health plan, or pay hundreds of dollars more a year in out-of-pocket expenses?

A wrap-up of this morning’s coverage of the September 23 events:

More on Virginia Health Care Lawsuit

The Wall Street Journal’s editorial this morning does a good job of summing up the significance of yesterday’s ruling denying the motion to dismiss in the Virginia health care lawsuit. (Politico has a news story on the ruling here.)  While the White House released a blog posting suggesting that the lawsuit was frivolous – judges should “ensure that our courts do not become forums for political debates” – Judge Hudson rightly noted that this case is novel in its sweeping scope, as the federal government has never penalized people for NOT buying a product. (Also worth noting: The White House’s blog posting did not attempt to defend the mandate’s constitutionality through the federal taxing power – indicating that the Administration is still attempting to “have it both ways” when it comes to saying that the individual mandate to purchase insurance is a tax.)

It’s also worth noting that the morning after the judge in Virginia rejected an attempt to dismiss the first challenge to the health care law’s constitutionality, the Senate will begin debating the Supreme Court nomination of Elena Kagan, who in an exchange with Sen. Coburn during her confirmation hearings pointedly (and repeatedly) declined to say that passing a law requiring individuals to eat three fruits and three vegetables a day would be unconstitutional.  As Judge Hudson noted yesterday, the health care law “literally forges new ground and extends Commerce Clause powers beyond its current high watermark” – a major constitutional development with which Ms. Kagan, during her confirmation hearings, expressed no qualms.