Obamacare - What Actually Changed?

. . . Other than a morass of new regulation? As the slow moving train wreck called the Patient Protection and Affordable Care Act rolls down its tracks of doom, it seems that many of the worst elements of health insurance have survived. All that has been added are layers of bureaucracy, as if even more regulation was going to help an industry choking on it. Here is the latest instance of plus ça change, plus c'est la même chose. From the Wonkblog at WaPo.

Under the health reform law, every insurance plan will be required to cover a set of “essential health benefits.” The Affordable Care Act defines 10 broad categories that must be included, such as “professional services of physicians and other health professionals” and “hospitalizations.” What fits within those categories is up to the Obama administration. Any plan that wants to sell on the new insurance marketplace will have to cover the benefits.
. . .
But what Health and Human Services created today wasn’t really an essential health benefits package at all. Instead, the department announced that every state will have the option to determine essential health benefits themselves, by using standards that already exist in their states. “The state is always in control of what the essential health benefit plan is in that particular state,” Steve Larsen, director of the Center for Consumer Information and Insurance Oversight, told reporters this afternoon.

How is that really different than today, where insurance is regulated by the states? The Secretary of HHS can now sue each state if he/she doesn't like their interpretation of the law, setting up politically motivated punishments of states by the federal executive branch, consolidating federal power. While the Obama administration would never abuse its power to sue a state trying to conform to federal law, what if those wascawy Wepubwicans ever win the White House? Something for you Democrats to think about.

Fruther, if the Supreme Court fails to strike down the individual mandate, the case is more important from a precedent setting perspective than from a practical one. The fines set for the individual mandate are not set high enough to get compliance. Further, there are weak enforcement mechanisms. From Randy E. Barnett in the New York University Journal of Law & Liberty.

Moreover, unlike Sonzinisky, the penalty does not even purport to be a tax. It is called a “penalty.” Although the penalty was inserted into the Internal Revenue Code, Congress then expressly severed the penalty from the normal enforcement mechanisms of the tax code. The failure to pay the penalty “shall not be subject to any criminal prosecution or penalty with respect to such failure.” Nor shall the IRS “file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section,” or impose a “levy on any such property with re- spect to such failure.” All of these restrictions undermine the claim that, because the penalty is inserted into the Internal Revenue Code, that it is a garden variety tax.

What did this atrocity really get us? More bureaucracy and regulation, less choice, maddeningly more complex regulatory landscape, more subsidies, more debt and a dubious precedent that will effectively grant Congress unlimited power over every person if upheld. Glad we had time to read the bill.