Tag Archives: health care

A Thought on the Contraceptive Mandate

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Notre Dame, et al., finally are getting their day in court concerning the Obamacare Contraceptive Mandate.  Notre Dame’s case centers on the premise that the government’s compromise in formulating the mandate still leaves religious organizations required to be agents authorizing contraceptive coverage, which violates Notre Dame’s (et al.) religious beliefs.

Two things about this case disturb me.  One is the Seventh Circuit’s attitude in hearing the case, as illustrated by this exchange:

Matthew Kairis (representing Notre Dame): The government is requiring Notre Dame to play a role.

Judge Richard Posner: But that role seems so trivial.

The role exists, and it forces the school to violate its fundamental religious tenets.  There’s nothing trivial about that.

The other thing is this argument by the government’s attorney, Mark Stern.  It’s a slippery slope, Stern claims, threatening the heart of the contraception mandate.  This goes along with his distortion of Notre Dame’s position:

It’s not enough that Notre Dame is going to get out of it, they don’t want anyone else to get in.

The first is at the center of the problem with the contraceptive mandate: the mandate forces religious entities and secular entities that try to operate according to their owners’ religious tenets (see, for instance, the Hobby Lobby case) to violate those tenets, and so is a violation of the Establishment Clause.  Of course the mandate should be threatened.  It should be eliminated.

As to the latter, surely Notre Dame has an opinion on the morality of other organizations providing contraceptives and abortifacients.  However, Notre Dame is not presuming to speak for them or about their legal right to provide these things, nor is Notre Dame arguing that health plan providers should be barred from offering coverage that provides these things.  Notre Dame and its fellow plaintiffs are merely arguing that they ought not be forced to be parties to the transactions.

Obamacare Failure

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Some random thoughts on President Barack Obama’s latest…delay…of inconvenient parts of his health welfare law:

House Speaker John Boehner (R, OH):

[O]nce again, the president is rewriting law on a whim.  If the administration doesn’t believe employers can manage the burden of the law, how can struggling families be expected to?

This latest rewrite, now being carried out by the Secretary of the Treasury Jack Lew in President Barack Obama’s name, is as lawless as Obama’s previous rewrites.  No authority to rewrite, or to refuse to enforce parts of, the Obamacare law or any other law exists in the Executive Branch.  Law writing and changing—both!—are the sole prerogative of the people’s elected representatives in the Congress.  What Obama is doing isn’t a rule adjustment in order to better effect the law, it’s a plain and simple refusal to enforce the law (under the guise of rewriting it), as the President and his Treasury Secretary are sworn to do.  And it was done solely for Democratic Party electoral gain; the move has nothing to do with what’s good for American businesses, and not at all with anything related to what’s good for American citizens.

Incidentally, the Treasurer’s oath of office is this (the President’s oath of office is in Art II, Section 1 of the Constitution):

I (name), do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter.  So help me God.

“Support and defend the Constitution of the United States” means, in this context, that the Treasurer is sworn to honor the separation of powers delineated in Articles I and II of the Constitution, which means in turn, he must do his part to enforce the law as it’s written; he cannot (as opposed to may not) rewrite it at convenience of for any other purpose.

I’m unsympathetic toward the insurers here.  Insurance company management wanted Obamacare, and they lobbied hard for it.  Now they’re reaping what they sowed, in terms of unbalanced costs.  The insurance companies’ management has been immoral and cowardly: they wanted to get into bed with government and take advantage of personal relationships with government bureaucrats and politicians so they could freeload off their fellow citizens and their tax money.  Instead, they should have chosen the path of being responsible fellow citizens themselves, taking advantage of their relationships with customers through free market.

As advertised, this…rewrite…is a temporary change, and the law will resume its full force in 2017 (conveniently after the next two elections, by the way).  As a temporary measure, it can have no effect on our economy, on business’ decisions as they operate in our economy, or on hiring (or not hiring).  This just extends the uncertainty, and it continues the drag on our economy and on Americans’ prosperity.  Any high school student of economics understands this, and so do Obama, Lew, and their Progressive fellows in Congress.

Again: this is a move purely for cynical Party gain, and nothing else at all.

Regulations Begetting Regulations

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Insurers are facing pressure from regulators and lawmakers about plans that offer limited choices of doctors and hospitals, a tactic the industry said is vital to keep down coverage prices in the new health law’s marketplaces.

Yeah—Obamacare regulates what coverages must be offered and at what prices (i.e., at no increase in price while adding mandatory coverage for contraceptives, pre-natal care, maternity care, etc.  And regardless of whether the man required to buy a health plan needs these things.  Or the empty-nesters.  Or post-menopausal women.  Or…).

However, since the insurers can only control costs—and remain in this new business of supplying government-mandated welfare—by controlling how many doctors or hospitals are in their networks, now we “need” additional regulations to “instruct” the insurers in this area.

Under [a] new federal proposal, insurers selling plans in the federally run marketplace would be required to submit to the Centers for Medicare and Medicaid Services a full list of providers in a network before their plans are approved for listing in the exchanges.  In the future, regulators also plan to develop federal standards for the required number of providers.

And [Emphasis added]

California Insurance Commissioner Dave Jones said he plans to revise his agency’s standards for insurers’ health networks partly because current regulations don’t give him enough power to continue oversight after a health plan goes on the market.

And so on, across lots of states.

Of course, absent government’s Obamacare intervention in this “market,” such layers of regulation wouldn’t be necessary.  The bottom layer of regulation wouldn’t be necessary.

But then, what would these bureaucrats do for jobs?  How would Progressive politicians justify their elective jobs?

Program Design

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This begins with an objective, cold-eyed analysis of the requirements of the program—which means no a priori assumptions can be made.  Even the most blatantly obvious underlying premises must be questioned and tested.

For instance.

The architects and designers of Obamacare (I’m being generous with those terms, but let’s go with them and see where we wind up) assumed, without checking, the following:

  • just about everyone wants health insurance
  • health insurance will make people healthier
  • those with health insurance are more likely to seek care from physicians and less likely to go to emergency rooms

Michael Barone, in the WSJ article at the link above, provided some data on the legitimacy of those unchecked assumptions.

  • a McKinsey & Co survey of those believed eligible for ObamaCare health-care exchange Plans found all of 11% of those who bought new these last couple of months were previously uninsured
  • two small insurance companies reported that only 25%-35% of those purchasing were previously uninsured

On those other two…assumptions…Barone described an in situ State of Oregon randomized experiment (in function, if not in intent) in the form of a lottery for allocating scarce Medicaid funds to applicants.

  • after two years of Oregon’s lottery, there was no significant difference between Medicaid-insured and uninsured in blood-sugar level, blood pressure, and cholesterol levels
  • those with Medicaid plans were 40% more likely to go to emergency rooms than those without insurance

Where were the Obamacare program architects and designers?

Four Months On

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…and ObamaMart isn’t even letting its victims customers get ObamaMart’s errors corrected.

Now it’s a variant on Catch 22: first ObamaMart hits its customers with errors, then it can’t—or won’t—allow customers (22,000 of them) to correct those errors.  Those errors, so far, fall into three main categories.  They

  • charge too much for health insurance (quite apart from the fundamentally higher premiums compared to the canceled plans)
  • steer customers to the wrong insurance plan (quite apart from shunting them into Medicaid for which they’re not actually eligible)
  • deny customers coverage altogether (the ultimate insult: get the plan with which you were satisfied canceled by Obamacare, and then be told you’re not even eligible for Obamacare, the law that covers everybody)

Yet there is no mechanism in ObamaMart for dealing with these errors or correcting them.  Even when customers mail in their corrections, those just get scanned in and fed to the same computer systems that don’t work for the customers directly.  The backend that would allow Customer “Service” personnel to access those scanned-in customer-originated corrections in order to work them hasn’t been built.

ObamaMart’s workaround for one unlucky woman on a $22k per year salary whose erroneous Obamacare Plan is costing her $100/mo more on her premiums than she should be charged and a $4k higher deductible than she should be getting charged?  Pay up.  We’ll correct this later.  Promise.

Notice that those overcharges alone come to nearly a quarter of her annual income.  She’s supposed to pay an additional 25% of her annual income for ObamaMart’s error, and hope that, someday, she’ll get the right plan and her money back.

The Centers for Medicare and Medicaid Services, the HHS agency responsible for ObamaMart and for administering the Obamacare law, doesn’t care about this failure, either.  According to The Washington Post (the above link) [emphasis added],

Three knowledgeable individuals, speaking on the condition of anonymity about internal discussions, said it is unclear when the appeals process will become available.  So far, it is not among the top priorities for completing parts of the federal insurance exchange’s computer system that still do not work.

And that’s just Obama’s store.  Obama’s law is even more unworkable, expensive, and disastrous, as we’ve also been seeing, with the millions of health policy cancelations over these same last four months.  As the “glitches” continue to get fixed, as I have no doubt they will, even more of the failures of Obamacare itself will become apparent.

It’s also typical of this administration.  Wind it up, set it loose, and forget about it.  Who cares if it doesn’t work?  That’s someone else’s responsibility.