Those who want to leave ObamaCare as it is are outnumbered more than 5 to 1 by those who want to repeal or change it.
President Obama keeps insisting the debate over ObamaCare is “over.” That declaration, wish, exhortation or command does not correspond with reality. A new Politico poll of voters in “hotly contested areas”–states and congressional districts thought to have competitive Senate or House contests–finds that 60% “say they believe the debate over the law is not over,” whereas only 39% “echo the president’s position” that the “debate has effectively concluded.”
The areas sampled are probably a bit more Republican than the nation as a whole: Of the 16 states chosen on the Senate side, Obama carried only seven in 2012. (On the other hand, they include Minnesota, Oregon and Virginia, which most handicappers currently list as “likely” Democratic holds.) Obama’s approval rating among the Politico respondents is 40%; RealClearPolitics had his nationwide average at 44% as of yesterday.
“At the same time that the health care law is plainly a political anchor for Democrats,” Politico’s Alexander Burns argues, “the poll signals that fully killing the ACA”–that’s the abbreviation for the law’s euphemistic formal name, Patient Protection and Affordable Care Act–“may not be a slam-dunk as a political proposition”:
Among voters who had an opinion of the ACA, the electorate was almost exactly split between those who want to repeal the law entirely and those who favor either leaving it alone or keeping it in place with modifications.
Forty-eight percent of respondents endorsed repeal, versus 35 percent who wanted to modify the law without repealing it and just 16 percent who said it should be left unchanged.
Of course the vast middle ground of “modify the law without repealing it” is terra incognita. It is as accurate as Burns’s formulation, and no less precise, to say that those who want to leave the law as it is are outnumbered more than 5 to 1 by those who want to repeal or change it.
There’s an additional ambiguity: What does it mean to leave the law “unchanged” when the Supreme Court has already struck down parts of it and the administration has declined to follow or enforce others? That’s not a salient question for immediate electoral purposes; in terms of voting intention, “left unchanged” can be taken as a statement of support for the Democrats. But even if the statutory language proves resistant to any effort at modification, there will be a new administration after 2016. That could mean more discretionary (or extralegal) changes and perhaps the end of ObamaCare as we know it.
“ObamaCare as we know it” is also an ambiguous turn of phrase, to say the least, for what do we know of ObamaCare? A few provisions are relatively straightforward, such as the expansion of Medicaid eligibility (in those states that have gone along with it) and the mandate that family insurance plans cover 23-, 24- and 25-year-old children of policyholders.
But the whole of ObamaCare is an insanely complicated scheme that even experts are still struggling to understand. “We have to pass the bill so that you can find out what is in it–away from the fog of the controversy,” then-Speaker Nancy Pelosi famously said in March 2010. We’ll be finding out for many years to come, and there’s no reason to think that “fog” will ever lift.
Here’s one example, reported the other day by the Washington Post:
The government may be paying incorrect subsidies to more than 1 million Americans for their health plans in the new federal insurance marketplace and has been unable so far to fix the errors, according to internal documents and three people familiar with the situation.
The problem means that potentially hundreds of thousands of people are receiving bigger subsidies than they deserve. They are part of a large group of Americans who listed incomes on their insurance applications that differ significantly–either too low or too high–from those on file with the Internal Revenue Service, documents show.
The government has identified these discrepancies but is stuck at the moment. Under federal rules, consumers are notified if there is a problem with their application and asked to upload or mail in pay stubs or other proof of their income. Only a fraction have done so, according to the documents. And, even when they have, the federal computer system at the heart of the insurance marketplace cannot match this proof with the application because that capability has yet to be built, according to the three individuals.
“Deserve” is an odd choice of words in the first sentence of that second paragraph. Has anyone done anything to deserve any of this? (Maybe so: As H.L. Mencken observed: “Democracy is the theory that the common people know what they want and deserve to get it good and hard.”)
The point is that as many as a million people have claimed subsidies to which they are not entitled under the law, and the administration hasn’t figured out what to do about it. Adrianna McIntyre of the pro-ObamaCare site Vox.com explains that the framers of ObamaCare included a provision to give it to these people good and hard:
Intentionally lying about income to boost your Obamacare tax credits could get you into hot water–$25,000 to $250,000 of hot water. That’s a key takeaway from guidance recently released by the Obama administration. . . .
According to the regulation, the $250,000 penalty is for “knowingly and willfully” providing false information. The more modest $25,000 fine can apply in cases where people provide incorrect information without malicious intent. In both cases, these are the maximum penalties that the government can impose. . . .
These regulations were just finalized, but the Obama administration did not design the penalties; they are spelled out in the text of the Affordable Care Act itself.
“But will the federal government actually take advantage of their legal capacity to prosecute offenders?” McIntyre asks. Probably not, she answers: “After all, if people are lying on their insurance applications because they can’t afford insurance, it’s not likely that they can cover these fines.”
“The IRS isn’t likely to bring such proceedings to earn a pittance,” Nicholas Bagley, a law professor at the University of Michigan, tells McIntyre. Then again, it wasn’t money the Obama IRS was after when it embarked on a campaign of harassment against conservative nonprofit organizations. These ObamaCare penalties may be too draconian to be applied generally, but applied selectively, they could be a powerful weapon of an abusive administration.
And because ObamaCare leaves in place the law giving states the authority to regulate the insurance industry, Washington isn’t the only prospective source of incompetence and abuse. Last Wednesday we noted that Seattle Children’s Hospital had sued Washington state’s insurance commissioner for approving plans that excluded it from their networks, thereby leaving some Washington families without access to pediatric care. The next day, the Puget Sound Business Journal published this report:
The Office of the Insurance Commissioner (OIC) has placed an administrative judge on paid leave after she blew the whistle, accusing the agency’s second-in-command of inappropriately trying to influence her decisions.
Chief Presiding Officer Patricia Petersen filed a document Tuesday stating that Chief Deputy Commissioner James Odiorne contacted her repeatedly over several months, which she contended was a violation of state law intended to preserve judicial independence.
Petersen said in the document that she believed Odiorne contacted her in an effort to influence her decision on cases related to the Affordable Care Act, including a suit that Seattle Children’s Hospital filed against the OIC.
Meanwhile, Reason’s Steven Greenhut reports that “in California, the biggest threat to the program’s implementation now is coming from the left”:
An initiative that has qualified for the November 2014 ballot, called the “Insurance Rate Public Justification and Accountability Act,” would impose the kind of price controls on health insurance that exist on California auto, property and casualty insurance. And Obamacare’s champions fear that these rules would strangle the state’s health care exchange, called Covered California, with profiteering, delays, and too much regulation.
Talk about ironies!
They have reason to worry. Thanks to an adversarial insurance pricing system that pays consumer groups to serve as “intervenors” who challenge rate hikes in the regulatory and legal process, it can take a year or more for companies to get government approval to adjust rates. Such long delays could hobble a rapidly changing and complex health insurance market.
Greenhut reports that “some say” Proposition 103, the initiative applying price controls to auto insurance, “actually has boosted the profits of insurers”: “No insurer wants to face that legalistic rate-changing process. So when prices are falling, insurers sit on their higher, regulated rates–rather than lowering them to lure new business.”
The new initiative may not pass; Greenhut reports that “a broad political coalition is growing to oppose the ballot measure.” Thanks to ObamaCare, liberals are beholden to insurance companies as well as vice versa (talk about ironies!).
Even so, it seems clear that the complications of ObamaCare–some intended, some not–will continue to multiply in the years to come. That makes it fanciful to think the debate will end anytime soon.
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James Taranto is a member of The Wall Street Journal‘s editorial board.