It’s a false headline I’ve seen at least twice now about King v. Burwell, the Obamacare premium assistance case coming up in the Supreme Court: FOUR LITTLE WORDS.
At issue in that case is one of many restrictions for when and how much premium assistance is available under 36B. The limiting language of 36B covers limitations for the availability of premium assistance including income restrictions, types of plans for which federal money is available, the restriction of additional assistance when State plans provide more than federal requirements, and the King v. Burwell restriction requiring enrollment “…through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act.”
The government seeks to minimize the provision and its importance and so Obamacare fans have resorted to excluding the “…under 1311 of the Patient Protection and Affordable Care Act,” portion of the provision. Why? Because under 1311 of the PPACA excludes what have come to be known as federally facilitated exchanges (never mentioned in the Act). Reference to a federal role in the ESTABLISHMENT OR IMPLEMENTATION of an Exchange is only mentioned in 1321 in connection with the situation described as “FAILURE TO ESTABLISH EXCHANGE OR IMPLEMENT REQUIREMENTS," (PPACA 1321). They advocate a reading of 36B that says, “…through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act [OR NOT]." They should just argue the omission of TWO LITTLE WORDS, OR NOT, rather than ignore the FOURTEEN words of the provision.
As consumers, we should be accustomed to the BEST-CASE HALF-TRUTHFUL scenario of Obamacare. Only the zealots remain convinced for the most part that Obamacare is REFORM rather than just another COST-SHIFTING MEASURE that ultimately takes more from consumers who pay for health insurance. Only those invested in the reputation of Obamacare rather than the fact of Obamacare simply cannot give up the half-truth.
As consumers this harms us because the inevitable impact of Obamacare on our wallets, our options and ultimately our health are being glossed over by the half-truth instead of addressing modifications that could well prevent us from suffering such obviously predictable hurt in the event of illness such as advocating against the continued rise in deductibles, or advocating for a fix to the family glitch.
Realizing how bad our insurance is after the fact of illness is the way it’s always been and the Obamacare zealots perpetuate this problem cold-heartedly willing to have others die for their cause. Yet I have sympathy for them.
We all wanted reform and I share the disappointment in what we got with Obamacare so I can understand why the half-truthers cannot face the fact that Obamacare is just more ordinary upheaval based on the same flawed reasoning we’ve seen before that ANY health insurance is better for health rather than focusing on what coverage that health insurance provides.
The only time “any” health insurance is better is when you had NO health insurance to begin with AND when that health insurance pays for virtually everything with very little out-of-pocket cost, so that yes, expanded Medicaid is working. For everyone else, it's become increasingly obvious that regardless of premium the expense of healthcare services is bad and growing with the trend of increased deductibles and more out-of-pocket costs for needed healthcare.
This is a "same-old" situation but is arguably worsened by Obamacare because of mandatory "free" checkups that health insurers use as an excuse for increased prices that unevenly provide “free” stuff so that men who have to help pay for a woman’s annual wellness exam under Obamacare cannot obtain a similar wellness checkup for “free” and so that non-parents have to purchase health insurance that covers dental for children under Obamacare even though in order to use that coverage for a child a person would have to separately purchase health insurance for the child.
The Obamacare zealots so wanted the law to be something extraordinary. But it’s ordinary for the most part. Mostly it’s a cost-shifting mechanism that instituted a health insurance tax penalty requiring people to purchase health insurance that wrongfully expanded the idea that having health insurance would improve health regardless of the COVERAGE provided by that health insurance so that it also includes some really insufficient health insurance options.
(Even with premium assistance the Congressional Budget Office found that more individuals than they anticipated were purchasing bronze plans to save money on premiums which in turn has made the CBO anticipate lower payments of premium assistance and cost-sharing, because cost-sharing is only available for silver plans and better).
Anyone who knows anything about our healthcare crisis knows that this inability to afford to pay medical bills even WITH health insurance contributed to the rate of uninsured (often combined with the high price of purchasing health insurance with insufficient coverage).
The novelty of Obamacare has primarily been in the expansion of Medicaid (which I support but is not healthcare “reform” just a recognition that providing free health insurance and virtually free healthcare is good) and in the pre-payment of premium assistance for eligible enrollees which is why King v. Burwell has the government arguing that it wants to provide premium assistance to as many people as possible.
But regardless of King v. Burwell, premium assistance will not be enough to make Obamacare work for consumers even in terms of the government’s limited goal of ENROLLMENT, counting who has health insurance rather than who has sufficient coverage.
The Congressional Budget Office doesn’t worry about premium assistance paid by the government because, “THE ACA specifies that if total exchange subsidies exceed a certain threshold in any year after 2017—a condition that CBO and JCT expect may be satisfied in some years—people will be required to pay a larger share of premiums in the following year than would otherwise be the case,” (CBO, 1/15/15).
For the CBO if premium assistance payouts get too big, no problem, enrollees will pay a larger share of premiums.
Additionally, right now premium assistance is costing the government LESS than was anticipated because, according to the CBO, “Lower estimated enrollment in coverage obtained through the exchanges in every year accounts for the majority of the $28 billion reduction in the estimated cost of premium assistance tax credits,” (CBO, 1/15/15).
Then there’s the practical worries. If premium assistance is extended to all enrollees why would states choose to establish or implement their exchanges if they haven’t done it already? Likely, the already lower-than-anticipated participation in the 1311 exchanges will stay low and the Obamacare zealots will be forced into the continued half-truths to justify the increased involvement, financing, and role of the federal government in healthcare or worse yet have to lie to defend the next steps the federal government takes to “manage” its costs whether it’s hiding them in the incalculable “indirect” costs of Obamacare or whether the government accommodates its role as the main EXCHANGE and increases user fees charged to insurance companies to participate in Obamacare, or any other means that could be used to finance this Federal Exchange simply to keep Obamacare going.
I support the idea of premium assistance for consumers but NOT when such premium assistance is merely used to boost enrollment rather than increase the COVERAGE protection for the individuals’ expenses of illness because even FREE premiums will not help people regain health if they can’t afford the out-of-pocket expenses. Obamacare fails on this.
I also don’t support the government’s Obamacare habit to rewrite the law and implement it differently from its provisions rendering a law that fails to resemble what was passed as in the instance of the employer mandate, the changes in penalties imposed on physicians for failing to meet certain quality measures, the effective dates in the law and now regarding premium assistance. That "flexibility" and liberty the government is taking is destroying the alleged “transparency” the law supported. You can’t see something that isn’t there.
Make no mistake, if the government wins it is a decision supporting exactly what Sylvia Burwell referred to, a FEDERAL EXCHANGE, neither anticipated, referred to or defined within the 1,000 pages of the Affordable Care Act. It's not just the FOUR LITTLE WORDS (or FOURTEEN) that are at issue.
