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| Economy |
| Capretta and Levin: Why ObamaCare Is Still No Sure Thing |
| 2012-11-19 |
| The majority of state governors are Republicans, and they have the power to disarm the health-care law. Champions of ObamaCare want Americans to believe that the president's re-election ended the battle over the law. It did no such thing. The Patient Protection and Affordable Care Act won't be fully repealed while Barack Obama is in office, but the administration is heavily dependent on the states for its implementation. Republicans will hold 30 governorships starting in January, and at last week's meeting of the Republican Governors Association they made it clear that they remain highly critical of the health law. Some Republican governors—including incoming RGA Chairman Bobby Jindal of Louisiana, Ohio's John Kasich, Wisconsin's Scott Walker and Maine's Paul LePage—have already said they won't do the federal government's bidding. Several Democratic governors, including Missouri's Jay Nixon and West Virginia's Earl Ray Tomblin, have also expressed serious concerns. Talk of the law's inevitability is intended to pressure these governors into implementing it on the administration's behalf. But states still have two key choices to make that together will put them in the driver's seat: whether to create state health-insurance exchanges, and whether to expand Medicaid. They should say "no" to both. At its core, ObamaCare is a massive entitlement expansion. Between vastly increased Medicaid eligibility and new premium subsidies, it is expected to bring 30 million more people onto the federal government's entitlement rolls. The law anticipates that the states will take on the burden of implementing the expansions, but states can opt out of both. Running the exchanges would be an administrative nightmare for states, requiring a complicated set of rules, mandates, databases and interfaces to establish eligibility, funnel subsidies, and facilitate purchases. All of this would have to take place under broad and often incoherent statutory requirements and federal regulations that have yet to be written. The exchanges would create unsustainable pressures on each state's insurance market, treating similarly situated people differently by providing far greater subsidies for those in the exchanges than those in employer plans—yielding perverse incentives that distort consumer and employer decisions and increase costs. States would endure all this simply to become functionaries of the federal government. The idea that creating state exchanges would give states control over their insurance markets is a fantasy. The states would be enforcing a federal law and federal regulations, with very little room for independent judgment. Governors know this. A group of them has already indicated that they will not build the exchanges, and several more seemed ready to opt out as the administration's deadline for state decisions approached on Nov. 16. Predictably, Health and Human Services Secretary Kathleen Sebelius tried to head them off by extending the deadline to Dec. 14. She will try to use the extra month to twist governors' arms. They should resist. By declining to build exchanges, the states would pass the burden and costs of the exchanges to the administration that sought this law. And it is far from clear that the administration could operate the exchanges on its own. Congress didn't allocate money for administering federal exchanges, and the law as written seems to prohibit federally run exchanges from providing subsidies to individuals. The administration insists that it can provide those subsidies anyway. But if the courts read the plain words of the statute, then federal exchanges couldn't really function. Thus states that refuse to create their own exchanges would effectively be repealing a large part of the law—sparing their citizens from the job-killing employer mandate and from assaults on their religious liberty. In some cases people would even be spared from the individual mandate to buy coverage, since in the absence of exchange subsidies more families would qualify for exemptions from the mandate. The Medicaid expansion, meanwhile, would throw millions of additional Americans into a system that is already bankrupting state governments and increasing costs in the private-insurance market. Medicaid's payments for services are so low that many existing beneficiaries have trouble finding physicians and other health-care providers who will accept them as patients. Enrolling more people without reform will push the system to the point of collapse. In refusing the Medicaid expansion, governors should notify Washington that doing so means freeing themselves of ObamaCare's "Maintenance of Effort" requirements. These would prohibit states participating in the Medicaid expansion from reforming their Medicaid systems to reduce costs. Instead of following the Obama administration's plan, states should seek real reform. For example, they should demand that Washington transform the federal portion of Medicaid for non-disabled and non-elderly beneficiaries into a uniform block grant, with state discretion over eligibility and benefits. The goal should be to turn Medicaid into a premium-assistance program rather than government-run insurance. Medicaid could then be used to help people enroll in mainstream insurance plans. This is the way to help the low-income uninsured get the same kind of coverage as other Americans. President Obama won re-election and Democrats maintained control of the Senate this month, but the states hold the future of ObamaCare in their hands. Knowing the harm the law would do to their citizens, to the economy and to American health care, governors should refuse to become its enablers. Mr. Capretta is a fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute. Mr. Levin is a fellow at the EPPC and editor of National Affairs |
| Posted by:Au Auric |
| #4 Think about this: the Fed program will require computer systems that far exceed any that have yet been implemented outside of classified ones. Examples: The FBI Virtual Case File System (started in 2001, cancelled as a complete failure in 2005, started over in 2006, and was finally introduced in March 2012. IRS Modernization -The IRS launched its Business System Modernization program about 25 years ago. By 1995 and $2 billion in expenditures, only marginal improvements were made. In 1999, an IRS assistant commissioner called the modernization program a failure, and said most of its technology did not work. By then, the IRS was starting over with a new $5 billion contract that has continued with mixed results. And remember - the IRS will be enforcing the "penalty" phase of this. Then in Texas, the Health and Human Services issued a contract valued at $899 million over five years with Accenture Ltd in 2005 - the program was supposed to determine eligibility and maintain an eligibility computer system, furnish call center services and provide enrollment broker services for health insurance in the state. It got scaled back project the following year due to failures in developing the systems. The project was plagued by complaints of slow service and the denial of benefits to eligible recipients, and was abandoned in March 2007. This thing is going to be an unholy mess - in addition to being willfully ignorant of the huge negative impacts on health-care availability and large increases in costs, the idiots that passed Obamacare certainly had no understanding of what it will take to implement the system. They seem to think passing a law will magically make complex systems appear. Wrong. Reality is going to bite hard. |
| Posted by: OldSpook 2012-11-19 23:03 |
| #3 ...databases and interfaces to establish eligibility... Can anybody think of a government computer project that came in on time and under budget? Every one that I ever heard of cost millions upon millions of dollars. There always seems to be a heckuva lot of fudge factor in these types of projects. |
| Posted by: Ebbang Uluque6305 2012-11-19 12:01 |
| #2 When the uninsured begin to see their IRS Earned Income Tax credit and Form 1040 refund decremented to pay the penalty, a light may..... (I say again may) come on! |
| Posted by: Besoeker 2012-11-19 10:05 |
| #1 If ObamaCare is impossible, it won't happen. Thank heaven for reality. |
| Posted by: Anguper Hupomosing9418 2012-11-19 09:11 |