As Obamacare comes closer and closer to coming on line, Republicans are getting desperate how to stop it. I suppose I should give them credit for at least one thing. They are no longer claiming that it will be the end of all liberty or turn us into a Communist dictatorship or lead to T-4 or the mass murder of senior. Claiming such thing about something remote and far-off is one thing. Claiming it about something due to come online in about six months is another. It is too easily falsifiable to be even remotely plausible as a claim. Instead, Republicans are starting to make legitimate complaints about problems that might actually occur. They worry that employers will refuse to give people full time work to avoid paying for their insurance, or that premiums will rise, especially for the young and the healthy (with no mention of the subsidies that will help people afford those premiums).
Still, I do note that their objections look mighty shifty. Until the individual mandate was upheld by the Supreme Court, it was the absolute worst feature of the law. Individual mandate was the end of all liberty; it allowed government to dictate anything and everything people could do; government could even force people to eat broccoli. Law supporters responded that the individual mandate was necessary to prevent people from postponing buying health insurance until they were sick and sending the system into a death spiral. Well, now that the individual mandate has been upheld, it appears that the greatest flaw in the system is that it is not sufficiently enforced, that with such mild penalties, some people might decide not to buy insurance until they are sick and send the system into a death spiral. And, of course, they are doing their best to keep people from buying insurance and thereby accelerate the process. And they plan to run on repealing Obamacare in 2014.
Still and all, I see an obvious problem there. So far, it is hard to generate much enthusiasm about the program because very few people have benefited from it. But what happens when people do? Certainly, it appears that not as many people will sign up for insurance as we had hoped, but some will -- probably not a trivial number. And suddenly in 2014 running on a promise to repeal Obamacare will mean running on a promise to take people's health insurance away. That really looks like a losing proposition to me.
Or consider another matter. The statute provided for subsidies for people buying healthcare on state exchanges, but not on federal exchanges. The assumption was that all states would set up exchanges. In fact, some 28 states refused, so federal exchanges were substituted. The IRS implemented regulations allowing subsidies for people buying insurance on exchanges. Now various groups have sued to block the regulation. Granted, the regulation is legally and constitutionally suspect, but the problem is (theoretically) easy to solve simply by slightly modifying the originals statute to allow subsidies on either federal or state exchanges. So the question is not simply whether the regulation is statutorily or constitutionally sound, but also whether it wiser on either a political or a policy basis to block the regulation, rather than to correct the error. Defenders of the suit argue that it will protect employers from having to pay fines for not insuring employees if their employees are not eligible for the subsidy. Ignored is the more important effect -- that it will "protect" people who would otherwise want to buy insurance on the exchanges from getting subsidies to do so. So, there will be people wanting insurance, but unable to afford it and facing fines for not having it who will resent the law. And by narrowing the pool of people buying insurance, it will encourage a death spiral. So if your goal is to kill Obamacare, it makes perfect sense from a policy standpoint.
But consider the politics of it. Yes, if people buying insurance on federal exchanges are blocked from subsidies before January 1, 2014, they will be presented with promises of insurance they cannot afford and fines for not having it and be justifiably resentful. Arguments that Republicans are blocking their subsidies, or that people in a neighboring state with its own exchange are getting them will probably not go very far. Politically, it will work to Republicans' advantage. But the chances of that happening in the next since months at any higher a level than federal district court are not high. And the chances of the Supreme Court making it the national law of the land within that time are essentially nil. Which means that if the lawsuit succeeds, it will occur after people have already started getting subsidies to buy insurance and will suddenly have them cut off. The political pressure to fix the problem will be rapid and intense. And if it becomes clear that Republicans consider it a proud achievement to have cut off those subsidies and will move heaven and earth to keep anyone from getting them back -- well, I have to imagine they will pay a price at the polls.
Sounds good to be objective in every politics condition.
ReplyDelete