Health law commentary: A series of delays; Senators' ideas for a fix; GOP should drop 'excuses' in Va. Medicaid debate

Mar 28 2014

The Wall Street Journal: The Individual Mandate Goes Poof
One by one, the myths of the Affordable Care Act have been revealed. When the curtain on open enrollment falls on March 31, the last remaining big myth of ObamaCare will be fully exposed: The individual mandate has failed. After a last-ditch effort with President Obama himself encouraging "young invincibles" to sign up before the deadline, the administration is scrambling to boost enrollment. On Tuesday, the White House announced that people who applied for coverage on the federal health-insurance exchange will have until mid-April to finish the paperwork (Abby McCloskey and Tom Miller, 3/26). 

The Wall Street Journal: ObamaCare Delay Number 38
Liberals say they believe in a living Constitution, and apparently they think the Affordable Care Act is a living document too. Amid one more last-minute regulatory delay, number 38 at last count, the mandate forcing nuns to sponsor birth control is more or less the only part of ObamaCare that is still intact (3/26). 

Bloomberg: Three Possible Reasons For Latest Obamacare Delay
When Kathleen Sebelius, the Health and Human Services secretary, said earlier this month that there would be no more delays of the Affordable Care Act's individual mandate, perhaps you naively thought that this meant that open enrollment would close on March 31 and anyone who didn't have health insurance by then would be, well, subject to the individual mandate. No, no, don't chide yourself -- that's also what I thought, and I'm so cynical that lemons pucker up when they look at me (Megan McArdle, 3/26).

Bloomberg: Obamacare Will Never Be Popular
Even if the ACA works as well as supporters hope, many benefits will be either invisible to consumers or difficult for them to trace to the law. For example, many people won't realize that before the ACA they would have been excluded from insurance because of a pre-existing condition -- even a minor one. Meanwhile, anyone who has anything go wrong with their health insurance will find it easy to blame Obamacare (Jonathan Bernstein, 3/26).

Politico: The Baghdad Bob Of Health Insurance
A core competency of Health and Human Services Secretary Kathleen Sebelius is issuing false assurances that all is well with Obamacare. An administration about-face has left the Cabinet official looking like the Baghdad Bob of American health insurance. When Rep. Kevin Brady (R-Texas) asked her at a hearing two weeks ago whether the administration would extend the Obamacare enrollment period beyond March 31, she responded with a crisp and direct: "No, sir." To the uninitiated, that sounded like an unmistakable denial of any intention to delay the enrollment period. The uninitiated were sadly misled (Rich Lowry, 3/26).

The Fiscal Times: Total Costs Tell The True Story Of Obamacare
The Obama administration is extending the enrollment deadline for the Affordable Care Act past March 31 and is describing the move as a consumer-friendly change that will allow insurance shoppers who haven't finished their applications to still qualify for coverage. Whether or not there's a last-minute rush of enrollments, now that the new exchanges have drawn some 5 million sign-ups, the biggest test of the reform will be if Obamacare policies actually succeed in providing affordable health insurance to more than 30 million Americans. That test will revolve around one concept: Total cost (John F. Wasik, 3/26).

The Fiscal Times: Obamacare: Taxpayers In The Hole For $1.5 Trillion
"What the hell is this, a joke?" Speaker of the House John Boehner said in reaction to news this week that yet another "deadline" in the Affordable Care Act had been unilaterally delayed by the Obama administration. Unfortunately, the answer to that question is yes, and it's becoming increasingly clear that the joke is on the American taxpayer. Late Tuesday, the Department of Health and Human Services – which has taken to bragging about "enrollment" numbers that fall millions short of their original goals – announced that the March 31st deadline for open enrollment had become more of a guideline. For those who could not navigate the troublesome Healthcare.gov web portal in time to meet the cutoff date for accessing approved plans, HHS would now keep the portal open and plans available for purchase, as long as users attested to the fact that they were "in line" for processing before the deadline. Since the announcement came almost a week before the deadline, that either suggests that it typically takes longer than that to complete an application, or that the website is more popular than a Lady Gaga concert (Edward Morrissey, 3/27).  

Politico Magazine: How To Fix The Affordable Care Act
As each of us has said from the beginning, the ACA is not perfect. And as each of us has promised, we are taking important steps to make the law work even better for families and small businesses across the country. From repealing the 1099 filing requirement to easing the paperwork burden on small businesses to allowing individuals to "window shop" for their insurance options on HealthCare.gov, we have already eliminated several unnecessary and bureaucratic barriers while maintaining consumer protections that provide invaluable peace of mind to millions of Americans. But there is more to be done. That's why today we are laying out some next steps to further improve implementation and ease the transition not only for individuals and families, but also for small businesses (Sens. Heidi Heitkamp, D-N.D.,  Mary Landrieu, D-La.,  Mark Begich, D-Alaska, Mark Warner, D-Va., Angus King, I-Maine, and Joe Manchin, D-W.Va., 3/26).

JAMA: Judgment Day For The Affordable Care Act?
There is now less than a week to go before the end of the Affordable Care Act's (ACA's) first enrollment period. The mainstream media will be filled with what journalists call "thumbsucker" stories-;news analyses of how we got to where we are and what it all means. ... Much of the focus over the next few weeks will undoubtedly be on the total number of people signing up on the exchanges. ... The ACA has many aims, and any law this complex will also have unintended consequences, both good and bad. However, if there is one overarching goal of the law, it is to decrease the number of uninsured individuals in the United States, which stood at 48 million in 2012. Unfortunately, measuring this effect will take time, and it goes well beyond simply looking at the number of people signing up in exchanges (Larry Levitt, 3/26).

Bloomberg: Even Conservatives Can Learn To Like Obamacare
[The health law is] easy to dismiss it as a failure. But here's something conservatives should begin to wrap their heads around: For all of our consternation, Obamacare may be a blessing in disguise. Make no mistake: The law still needs to be repealed, because it fails to deal with the fundamental issue of health costs, represents a huge federal overreach into health care, and raises taxes to support the creation of a huge new entitlement. But Obamacare also makes it easier, from both a political and a policy perspective, to move toward the kind of health-care reforms that conservatives have long argued for (Lanhee Chen, 3/26).

The New York Times' Taking Note: Facts & Figures: Clueless On The 'Obamacare' Deadline
The Obama administration said yesterday that it would treat the March 31 deadline for enrolling in a health plan somewhat flexibly. Consumers who begin to apply by March 31 will have until mid-April to finish. Relatedly, according to the Kaiser Health Tracking Poll for March, "substantial shares" of the uninsured population don't realize that the deadline to sign up for health insurance is fast approaching (3/26). 

Los Angeles Times: Contraception Exemptions May Help Hobby Lobby Win Obamacare Battle
The Supreme Court took up the question Tuesday of whether for-profit corporations had the right to exercise a religion, and the answer seemed clear from the justices' questions: closely held corporations do. ... But that may not be the deciding factor in the case. Just as important are whether the federal government can show a compelling interest in providing easy access to contraception, and whether the mandate is the least-restrictive way to promote that interest. And the administration's problem on that front appears to be the fact that there are exemptions -- granted by the law and by the administration -- to the mandate (Jon Healey, 3/26).

Bloomberg: Hobby Lobby Verdict Could Be A Surprise
On the other side of the coin, Justice Sonia Sotomayor made a terrific point in oral argument that the parties had not raised -- and it deserves to be the centerpiece of a dissent if there is no majority for it. Sotomayor noted that both parties assumed that Hobby Lobby would be burdened by having to pay a penalty or fine if it chose not to extend contraceptive coverage to its employees. ... Justice Elena Kagan then chimed in. If the result of noncoverage is a tax, rather than a penalty, she suggested, then Hobby Lobby faces a choice, not a "burden" as required by the religious freedom act. It can either choose to end health-care coverage for all its employees and pay the $2,000 per employee tax, or it can provide contraceptive coverage. This, Kagan said, amounted to the government saying, "You can do this thing or if this thing violates your religion you can do another thing" (Noah Feldman, 3/26).

Bloomberg: Question We Can't Answer
How many uninsured people have gained insurance as a result of Obamacare? Earlier this month, the Congressional Budget Office projected that the number of uninsured would decrease by 13 million people this year thanks to the Affordable Care Act. Are we on track to make that number? The answer is "I don't know." And it will remain "I don't know" for a very long time (Megan McArdle, 3/26).

The Washington Post: Va. Republicans Need To End Their Excuses For Not Expanding Medicaid
Republicans in Virginia's House of Delegates are running out of excuses to refuse a huge pot of federal money for expanding health-care coverage to poor people. The legislature this week convened a special session, the product of House Republicans' baseless refusal to compromise on the health-care expansion. Both Virginia Gov. Terry McAuliffe (D) and the state Senate have offered compromise plans, responding to the House GOP's proffered reasons for opposition with more seriousness than they deserve. If the Republicans' opposition is anything beyond thoughtless or cynical, they should come to the negotiating table now (3/26). 

Richmond Times-Dispatch: DiSesa: Medicaid Expansion In Virginia? NO
Medicaid expansion is a cornerstone of the Affordable Care Act (Obamacare) and the president's 20 delays/changes are a clear warning his legacy legislation is unworkable as it was written four years ago. However, Gov. McAuliffe and advocates for expanding Medicaid are ignoring the president's advice. Unfortunately, as the evidence piles up they continue to make false claims trying to persuade Virginians that becoming more dependent on the federal government is in their best interests (Craig DiSesa, 3/27).

Richmond Times-Dispatch: Desmond: Medicaid Expansion In Virginia? YES
As a Virginia labor leader, I support Gov. Terry McAuliffe's plan to expand Medicaid because it is good for both workers and business. Medicaid expansion will create 30,000 new jobs in Virginia and inject more than $2 billion annually into the state. Jobs are the key to economic development in Virginia, and I applaud our governor for putting working families first. Unfortunately, many Republican members of the Virginia House of Delegates are opposing McAuliffe's Medicaid expansion plan. Republican legislators need to stop putting political ideology over what is best for our state (Dennis Desmond, 3/27). 

St. Louis Post Dispatch: Scared Senators Want The Medicaid Monster To Go Away
Like scared little boys huddling in a closet, the members of the Missouri Senate's so-called "conservative" caucus this week begged the monster under their bed to go away. The monster is Medicaid expansion. The senators want it to leave them alone because they can't make it go away on their own. Their intellectual argument on the merits of the issue has been laid bare by studies, colleagues, donors and other conservatives who have come to realize that balancing budgets and saving lives is a bit more important than simply hating Obamacare (3/25).

The New England Journal Of Medicine: Pinching The Poor? Medicaid Cost Sharing Under The ACA
In addition to Iowa, last year Arizona, Arkansas, and Michigan pursued Medicaid expansions that involve substantial cost sharing for low-income adults. ... How will these policies affect health care? Substantial evidence suggests that cost sharing at the point of care reduces utilization and spending.  ... Some state experimentation is undoubtedly worthwhile, but only if it's coupled with rigorous evaluation. ... Ultimately, if this sort of flexibility encourages more states to expand Medicaid, most low-income adults will be better off for the effort -; since some cost sharing is almost certainly preferable to being left without any coverage at all (Brendan Saloner, Lindsay Sabik and Dr. Benjamin D. Sommers, 3/27).