But amid the post-rollout political backlash, last week the agency created a new category: Now all you need to do is fill out a form attesting that your plan was cancelled and that you "believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy" or "you consider other available policies unaffordable."Well that was weird. The ACA individual mandate, the whole Supreme Court fight, if you recall, was about its core essentiality to the success of the law. And now the same Sebelius, defendant in National Federation of Independent Business v Sebelius, has very quietly gutted the individual mandate. As the WSJ article quoted above points out, the longer the mandate isn't enforced, the less likely that it will EVER be enforced. And I thought we were going to have to wait until 2017 to have a chance at repeal.
This lax standard—no formula or hard test beyond a person's belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified nonreason that "you experienced another hardship in obtaining health insurance," which only requires "documentation if possible." And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.
Katherine, we've got to gut this thing before the GOP can.
Republicans should publicize this ruling far and wide, declaring victory over this hated law. Then they need to work on real health care reform, because the problems with health care that has caused the electorate to tolerate the Democrats aren't going away either. As I have published before, here is a start:
Liberty Movement Health Care Plan (first published in 2011):
Here is the plan that John Mackey of Whole Foods proposed, my comments in italics.
- "Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts." Patients who have skin in the game and market knowledge will reduce costs faster than any government program.
- "Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits."
- Allow competition across state lines.
- "Repeal government mandates regarding what insurance companies must cover."
- "Enact tort reform."
- "Make costs transparent."
- "Enact medicare reform." Medicare policies that are mimicked by the private sector are strangling the medical profession.
- Revise tax law to make it easier to donate to those without insurance.
To expand on these points.
- The government could help lead this effort by reforming first Medicaid, by turning it into an insurance subsidy program for the poor. But the program would require those in the program to pay a high copay until a low catastrophic cap was reached. Such a system would create a market for a system where people have more incentive to shop for best value in medical care. This system could then be applied to Medicare.
- The next big issue is that health care is tied to employment. My first impulse is to forbid the offering of insurance through employment, but that would make a conservative social engineer, instead of a liberal one. Removing the tax advantage would at least set a level playing field. To date, the portion of employee compensation that comes in the form of employer health insurance isn't taxed as compensation. This ties employees to their companies and needlessly. You would think that liberals would be opposed to a scheme where tax policy gives corporations leverage over employees. However, I dislike schemes whereby the government imposes on employee relations, so I will settle for leveling the playing field.
- Interstate competition is not the norm in insurance. Surely the federal government has the right to "regulate" as in "make regular" this portion of interstate commerce, by insuring that any insurance offered for sale in a state would be available in the fifty states. Increasing competition will probably be opposed by the insurance industry, but freer markets benefit consumers.
- One size never fits all. So mandating coverage should be banned. Insurance is always tricky business, even homeowner's insurance, as Road Dawg can attest to. Along with no mandates will be the need to enforce clear language in policies and communications with policy holders. I am a libertarian, but not so naive as to believe that some insurance companies won't try to wriggle out of agreements to save money. Court is expensive for individual consumers, so regulation that enforces good practices of transparency and clarity will be necessary. But regulation should always aim for simplicity and this also needs to be part of a reform package.
- With regards to tort reform, we have seen positive results in Texas, where access to care increased after passage of reform.
- Cost transparency is important to enable process improvement and allow patient choice. Most people don't know the true cost of a medical visit, even after the visit is over. Here again, Medicaid reform could lead the way, by insisting that patients receive better notice and understanding of their bill.
- Medicare policies with regards to reimbursement are arcane and lead to huge misunderstandings on what is covered and unexpected bills. Transforming Medicare to save it for those who truly need it, into an insurance subsidy scheme, will get the government out of the rule writing business and free up insurance plans to compete.
- Allowing Americans to donate to those who need health care insurance might make little difference, but maybe not. I see lots of do-gooder millionaires wanting to pay more taxes. Maybe they could pay for poor people's insurance in the interim.