Non-citizens granted any sort of legal status by a congressional immigration deal or Executive fiat would immediately become eligible under Obamacare’s Basic Health Program BHP provisions for taxpayer-subsidized, Obamacare-compliant private health insurance plans, with better benefits and lower premiums than U.S. citizens.Such persons could also receive “cost-sharing” subsidies under Obamacare.The Senate comprehensive immigration reform bill, S.744 passed earlier this year, purports but fails to prevent persons newly granted “legal status” from receiving Obamacare subsidies.An HHS final rule issued in March extended Basic Health Program benefits to aliens lawfully present in the country from 0-200 percent of the official Federal Poverty Line FPL when the statute explicitly states that no lawfully present aliens above 133 percent of FPL are eligible.The statute clearly limits who is eligible for the BHP, but HHS’ rule opens the door to others being deemed eligible, contrary to the law, and without congressional approval.
David A. Hyman is the H. Ross & Helen Workman Chair in Law and director of the Epstein Program in Health Law and Policy at the University of Illinois Urbana-Champaign, as well as an adjunct scholar at the Cato Institute. Earlier this month, Hyman gave the following erudite presentation on the implementation of the Patient Protection and Affordable Care Act – which he calls PPACA, not “ObamaCare” or “the Affordable Care Act” – at a faculty seminar hosted by the University of Chicago’s MacLean Center for Clinical Medical Ethics.
Greg Fann, Wakely Consulting Group | Implications of Individual Subsidies in the Affordable Care Act—What Stakeholders Need to UnderstandMay 13, 2014
However, the following sections will illustrate that the subsidies will primarily benefit older people, as premium rates for younger people are more likely to be considered “affordable” before a subsidy adjustment. This reality is either unknown or overlooked when reliance on premium subsidies is the automatic explanation of why there is no reason to be concerned that young people may choose not to enroll in the individual exchanges.
The concern that young people will not enroll in enough levels to support the sustainability of the individual market is further strained by the widely known ACA provision requiring employers to allow children under the age of 26 to enroll or remain on their parents’ plans, as well as age compression of the individual market premiums that will discourage younger members from enrolling compared to premiums they would pay if age rating were on an actuarially appropriate basis. A detailed illustration of the premium subsidy calculation and resulting net premiums by age and income level is provided below.
The lesson to be drawn here is that a law as consequential as health care reform should not be written in a way that allows the executive to effectively rewrite it in an ad hoc and discriminatory manner. It invites bending the rules and pushing legal boundaries for political reasons.
It is also evident that the law’s huge concentration of power in the Department of Health and Human Services is, and will be, a serious mistake. This department now can make every important decision in the health insurance sector, and it is gradually accumulating power over the organization of the medical delivery system too. Consequently, the health system is responding to the steady flow of H.H.S. pronouncements, rather than to private initiative.
Over time, as recognition spreads that the federal government is now calling all of the shots in the health system, innovation and adaptation will suffer, and, in time, so too will the quality of American medicine. Instead of taking the initiative to seek or deliver higher value care, the key players — employers, providers, states and consumers — will look first to see what the government requires to ensure reimbursement for services. The result will be a steady increase in federal bureaucratic control, and a commensurate decline in the quality of American medicine.
As national Democrats prepare to run against the GOP on income equality issues, a giant union has issued a scathing Obamacare document that could undermine that case.
“The Irony of ObamaCare: Making Inequality Worse” is the title of the UNITE HERE (Culinary parent) document that is posted here and soon to be making its way to Capitol Hill. It is devastating to the Democrats. To wit:
Ironically, the Administration’s own signature healthcare victory poses one of the most immediate challenges to redressing inequality. Yes, the Affordable Care Act will help many more Americans gain some health insurance coverage, a significant step forward for equality. At the same time, without smart fixes, the ACA threatens the middle class with higher premiums, loss of hours, and a shift to part-time work and less comprehensive coverage.
The paper argues that the Affordable Care Act will transfer a billion dollars in wealth to insurance companies, create an unlevel playing field in the market, force employers to cut back hours and result in pay decreases. It lays it out in detail, with examples of union workers affected by Obamacare.
We cannot reconcile these republican notions with Obamacare’s disincentives to work. If we take the Framers’ hard-earned lessons seriously, the sort of clientelistic relationship that exists under Obamacare is incompatible with authentic citizenship. The problem arises from two different directions.
First, a government captured by factions will simply have more power than it previously did. Once people come to depend on those benefits, they will have little choice but to abide by whatever strings the government chooses to attach.
Second, the government will now have less to fear from its opponents. Dependency degrades the capacity of the citizenry to operate as a check on the antirepublican tendencies of the government. As Madison and Jefferson argued toward the end of the 1790s, this was the last, best hope for true republicanism. In their telling, a junto of financial elites from the Northeast had seized control of the government, perverting public policy towards their own, selfish ends. The only recourse was the ballot box, where they hoped to mobilize the people at large to stand up for the public interest. If the government has turned citizens into clients, how will the citizens then stand up to the government should it misbehave?
The structure of Obamacare’s subsidies for health insurance in the exchanges differs radically from proposals for tax credits commonly proposed by conservative or centrist policy analysts. Conservative reformers, Heritage among them, aim at making health care financing mechanisms predictable, fully transparent, and designed clarify the true costs of health care and increase the range of competitive choices. The entire approach is to create strong incentives for individuals to secure value for their health care dollars and economize in health care spending. Obamacare does exactly the opposite.
For now, nearly five million people ages 18 to 64 get no financial help to buy coverage because of the gap, according to estimates by the Kaiser Family Foundation. Many of those people are clustered in the South, living in states where income limits for Medicaid coverage have historically been among the lowest in the U.S.
Eugene Steuerle, an Urban Institute economist and former Treasury Department official who served under presidents in both parties, said he couldn’t recall a social program that excluded beneficiaries because they earn too little.
Under the scheme, a provision of Obamacare requires that staff members of every hospital in Massachusetts be paid at least as much as the members of the staff of the state’s rural hospitals, with the federal government paying for the extra cost of compliance.
As it conveniently happens, the only “rural hospital” in Massachusetts serves the rich and famous on the fashionable island of Nantucket, summer enclave of the rich and beautiful people, mostly Democrats.
The hospitals in bucolic Western Massachusetts must pay the same wages as the well-appointed medical “cottage” that caters to Nantucket’s 1 percenters, including Mr. Kerry. It’s a $257 million Medicare reimbursement bonus for Massachusetts.
It’s beyond outrageous. According to the Centers for Medicare and Medicaid Services, this scam will cost Arkansas hospitals $5.2 million, Louisiana will lose $6.7 million and North Carolina $12.6 million. The 2014ers are desperate to correct this imbalance before the autumn campaigns.
Here’s the bottom line: Obamacare has failed miserably on nearly every major promise made about it (Grade: F). The processes used to enact and implement the law have been tarnished by actions of questionable legality and a pervasive lack of transparency (Grade: D). On actual outcomes, Obamacare has fared better in the short term (Grade: C+), but there are worrisome signs that by most measures, the law’s performance will get significantly worse by the time final grades are handed out.
I’ll admit, I’m a pretty tough grader. In this era of grade inflation, some Americans may be inclined to be more generous. But after doing this for nearly four decades, I think I’m a fairly good judge of health policy work and its likelihood of success when put into practice. We’re only at midterm, but I’d have to say the long-term outlook for Obamacare is very poor indeed.