Friday, June 29, 2012

The Disembowelment of Obamacare?

Like most Americans, I have not read the 900, or 2,500, or2,700 pages (depending upon who your ask) of the Patient Protection and Affordable Care Act. It apparently is such a monstrousity that few people can agree even on its length.

I doubt the justices of the Supreme Court read the act in its entirety either.

They ruled that it is constitutional, to the surprise of many court observers.

I have not read  their opinion in its entirety, either.

From the "chattering classes" on television, we learned, however, several things from the ruling.

First, we learned that the Supreme Court finally found a limit to the extent to which Congress can use the “commerce clause” to enact whatever legislation it wants. Enumerated powers is something one only hears about in middle school civics classes these days, never on Capitol Hill.

Second, we learned that the incentive to force people to purchase health insurance is not a penalty, but a tax.

Remember when Nancy Pelosi said that Congress must pass the bill in order to find out what is in it:

Apparently, President Obama did not know what was in it either. He had to wait until the recent Supreme Court decision to find out that the mandate was a tax.

Third, we learned that the greatest expense of the PPACA has been thrown out. Or have we? No one in the “chattering classes” has addressed it. While the mandate, whether construed as a “tax” or a “penalty” may force those who can afford it to purchase health insurance, the mechanism for universal health care—the most expensive part of the PPACA-- has been thrown out. The PPACA required that states expand Medicare coverage beyond the elderly and those with special conditions to include anyone who falls below 133% of the poverty level. Moreover, the law empowered the Department of HHS to remove all Medicare funds from any state who failed to comply.

On page 51 of the Supreme Court decision, Roberts wrote that

In this case, the financial “inducement” Congress has chosen is much more than “relatively mild encouragement”—it is a gun to the head.

The administration claimed that this provision was simply a lawful modification of the existing Medicare program.

The court ruled, however, that

It is no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage.

On the basis that the PPACA is a new program and not an expansion of Medicare, the Court ruled that  government does not have the power to coerce the states.

They threw the most expensive—and expansive—part of the PPACA.


Mrs. AL (Always Learning) said...

Like your analysis here, RD. It's easy to have an instantaneous reaction and get fired up about it. The only thing I focused on was the individual mandate, which has now been deemed a tak. Thanx for the expanded analysis.

RightDetour said...

I keep waiting for more informed "professionals" to comment on this aspect of the decision. If none of the 26 states that filed suit choose to expand Medicare coverage, the PPACA will not be implemented in those states. Many other states may not comply. I wonder if even liberal California, because of their state budget crisis, may decide to opt out. Feds will subsidize the expansion of Medicare 100 % for the first few years; after that, it drops to 90%. Even that small drop means huge budget increases for a state like California. The same could be said for many other states as well.

Mrs. AL (Always Learning) said...

And, RD, it is the States that have to turn the national government around. We need to press exceptionally hard on our State legislatures, etc to take action on our behalf.