Rogue States
The revolt against ObamaCare
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GoogleAt the tail end of December 2009, as negotiations on the final Senate version of the health care overhaul were being completed, David Paterson, the Democratic governor of New York, held a joint press conference with independent New York City Mayor Michael Bloomberg in which they declared their unified opposition to ObamaCare. The legislation, they warned, would cost the state $1 billion, threaten the continued operation of many hospitals and nursing homes, and force the city to close 100 clinics. Bloomberg told the New York Daily News the law was “a disgrace.” A bitter Paterson groused that he felt like his state was being “punished.”
State politicians from the GOP were no less upset. A few days earlier, Mississippi Gov. Haley Barbour, president of the Republican Governors Association, had chided the Senate for “poor policy” and warned that the bill’s unfunded mandates “would necessarily cause states to raise taxes or cut vital services like education and law enforcement.”
Three months later, the fiscal punishment that both Paterson and Barbour feared was signed into law. Thanks to the unexpected election of GOP upstart Scott Brown to Teddy Kennedy’s old seat in the Senate, which left Democrats for the first time during the Obama administration without a filibuster-proof majority in the upper body—and thus without the ability to pass a revised version of the bill—the House chose to swallow hard and pass the Senate legislation unchanged, making only limited modifications in a follow-up reconciliation bill.
Much of the language that passed into law was never intended to be final; it was more like beta software. Most of the important elements the authors had intended to include were there, but not always in the final intended form. And the code was still crawling with bugs, particularly on the level of implementation: at the states.
But Democrats had heard the call of history. Passing any bill—even a creaky, obviously flawed beta version—was better, party leaders decided, than declaring defeat so tantalizingly close to the finish line. And so, on March 23, 2010, President Barack Obama stepped up to a White House podium to memorialize the signing of the Patient Protection and Affordable Care Act.
As he did, Vice President Joe Biden leaned over and whispered, near a still-hot microphone, “This is a big fucking deal.” As with all the best political gaffes, Biden’s slip of the tongue revealed the truth. ObamaCare dramatically increases state Medicaid burdens at a time when local budgets are in deep crisis, asks states to participate in a woefully underfunded bridge insurance program, and pushes state governments to set up complex health care “exchanges” that must be designed and run according to the administration’s standards—standards it has yet to define and can change at whim. The law is a big deal in every way, and the first institutions to absorb the shock are state governments. That’s why so many have already begun to resist.
Risky Business
In the middle of 2009, as congressional Democrats began to dig in on ObamaCare, they ran into a cost problem—or, more precisely, a political problem caused by estimated costs. Early drafts of the legislation had racked up Congressional Budget Office scores well north of $1 trillion, and the unheard-of price tag provoked an immediate backlash. By September, President Obama was promising the legislation would come in at “around $900 billion.”
In order to meet that promise, the law’s authors loaded the bill with budgeting gimmicks that made its first-decade top-line cost appear lower. (See “The Lie of Fiscal Responsibility,” June 2010.) One of those gimmicks was to delay the bulk of the law’s new benefits—and thus the bulk of its spending—until 2014. That meant the CBO’s traditional 10-year score, which covered 2010–19, accounted for only six years of spending.
It also meant that three and a half years would pass before the new, broad-based insurance subsidies kicked in and key new regulations took effect. That three-and-a-half-year gap translates into a three-and-a-half-year political nightmare for members of Congress intent on proving that the law is bringing immediate benefits to their constituents. Legislators therefore told states to immediately establish a network of new high-risk pools—state-run insurance options for those who might otherwise have trouble getting insurance due to various risk factors. Invariably, these pools will be populated by the least healthy, and thus the most expensive to insure. Yet ObamaCare also requires these pools to charge standard market rates, meaning they will require significant public subsidies. And the law provides just $5 billion in such funding.
In June, Richard Foster, Medicare’s chief actuary, told The New York Times that the $5 billion will run dry as early as 2011. A report from the union-automaker-backed National Institute for Health Care Reform and the Center for Studying Health System Change*, a non-partisan health care organization that conducts original health care research, projects that as many as 7 million individuals will qualify for the new plan. According to that report, there is enough funding to cover only about 200,000 of those people, or less than 3 percent. As a result, the center concluded, the program “could leave hundreds of thousands of potential participants with serious medical problems unable to obtain coverage.”
ObamaCare leaves states on the hook for the rest of the tab. On a conference call in early May, officials from the Department of Health and Human Services (HHS) reportedly tried to reassure state officials that they wouldn’t be stuck with the bill. But the HHS has yet to say where the extra money will come from. Against this grim backdrop, 21 states have refused to operate the new insurance pools, leaving their setup and operation to the federal government instead.
In part, states are balking at the idea of being micromanaged by the feds, telling Washington to do the job itself if it can’t butt out of the process. In the words of Grace-Marie Turner, president of the Galen Institute, a nonprofit health care research organization that advocates free-market solutions, “You basically have the states running something in which the federal government is telling them what to run.” The rebellion is also a reaction to the complexity and difficulty of the job. As William A. Hazel Jr., Virginia’s secretary of health and human resources, told The Washington Post in May, building a high-risk pool is “an enormously complicated undertaking.”
But to judge from the letters state officials have sent to HHS Secretary Kathleen Sebelius, the biggest complaint is cost. In one letter, Georgia State Insurance Commissioner John Oxendine wrote, “I am concerned that the high risk pool program will ultimately become the financial responsibility of Georgians in the form of an unfunded mandate.” Virginia Gov. Robert F. McDonnell wrote that his state would not participate because the money allocated to fund the program in his state would be used up in just 22 months.
With its high-risk “bridge” pools, Obama-Care has indeed created a bridge—to nowhere.
Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time.
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Does anyone else gag a little when he sees that picture? It's like the first time I saw a Hustler Magazine centerfold in all its gynecological gore. I knew it was bad for me, but I couldn't look away.
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Gynecological gore? Which issue? was it a post birth photo? or do you just not like the pussy?
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They got some UGLLLLLY pussy in Hustler.
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Hey!
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Pelosi in Hustler? I'm trying to eat lunch here, man!
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It's only bad for you, if you marry it!
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Nancy Seems to be enjoying herself. Immensely. She must have put fresh batteries in, just for the ceremony.
NTTAWWT
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The guy in the upper right? In the very back?
He's a replicant.
They can never get the hair right.
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Awesome.
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That's Blagojevich's half brother, Pol Combovabich.
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It looks like Patrick Kennedy. I guess he wasnt in a bar or a rehab facility on that particular day.
What I wanna know is who is the guy to Nancy's right? Wayne Newton?
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I think it's Tony Stewart.
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Why was Webster at the signing of the bill?
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Nancy decreed it. Don't ask.
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I'm just happy she didn't paint him green.
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I thought it was Gary Coleman, not Webster.
More interesting than that is the presence of Colonial President Laura Roslin.
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I guess Biden does make a better Mr Drummond than a George.
The most troubling part is Skeletor sitting on the front row next to Obama.
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What chou talkin' 'bout Willis????
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That photo amounts to a handy thank you note list for the fifty new Republican legislators on November 3.
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These rogue states are happy with Medicare and Medicaid, though, aren't they? There doesn't seem to be a pricipled opposition to big government health programs afoot. Maybe it's just a temporary outbreak of some virus that attcks brain cells.
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I certainly wouldn't expect any government to have a principled position on anything. But the article is describing numerous practical difficulties that the states will have with Obamacare. Care to comment on those?
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Trolls: can't live with 'em, can't live without 'em.
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I hear ya. But I'm really curious as to what Obama's butt monkeys have to say about this. Do they have anything other than the usual "you just want poor people to get sick and die!" and their favorite "teh racist!"?
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Yup. It's the same thing if you didn't want globalization of the U.S military... "You WANT people to suffer and DIE under TERRORISTS?". Political punchlines with no jokes attached. Rip off.
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Most normal people like plenty of things government does and happily pay taxes for the services government provides. So you can shove your anti-government fanaticism back up your fat ass where it came from, you ignorant fuck.
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If people like you are "normal" then I'm proud to be different.
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Stupider is different, asshole.
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I find it humorous when idiots such as yourself fail to understand something, and then insist that those who can are the stupid ones.
You're like the dumb kid in the back of the class who claims that the reason he fails is because the subject matter and instructor are stupid, meanwhile the smart kids get good grades.
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Max,
Actually, if you are normal, than that would put you somewhere between 80 and 120 iq. So, different would also be smarter- asshole (?)
Sorry, but I felt I must keep up the fucking trend of name calling.
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+10
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What a qualified statement. MOST NORMAL people like PLENTY of things...
So that means that some normal people (if I were to even believe your premise) do not like these same things. Actually, it would mean that (given that plenty is an ambiguous amount)Most normal people are apathetic about, or are opposed to PLENTY of things the government does.
What is the matter with this dude's brain?
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Most normal people oppose ObamaCare.
And, beyond that, Enjoy Every Sandwich's point was not that all government is bad, but that this particular law is creating very tangible problems. Do you disagree, or is posting here just a compulsion for you?
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No, fuckwit, for the idiot you refer to and his comnrades the government is mostly evil. It isn't just some tagible problems that this partuiclar law creates; it's the whole idea of unversal health care, and you fucking know it.
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The whole idea of universal health care is awful because of the tangible problems it poses- ass-face (there, I felt I needed to call you a name so you'd understand).
It would be great if no one was forced to participate and no one had to pay for it, etc. It would be great if you would pull your head out of Castle Car-a-lot and grow the fuck up.
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Actually the government is all evil. Be that as it may, it's the reality of the moment. Their "healthcare" program is reality...as are the problems with making it work. You can't just wish the problems away, or make them go away by chanting "Yes We Can!". To be taken even slightly seriously you have to address the problems.
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Max is does not understand distinctions.
For example he does not understand the distinctions between no government and limited government, free markets and crony capitalism, income and wealth, influence and control, as well as a host of other important distinctions that make rational thought possible.
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I'm surprised he hasn't told us all to move to Somalia: the "libertarian paradise". Or maybe he did and I just missed it.
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Surely at some point he has.
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Did someone conduct a survery that only polled normal people? How?
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I like all the money the government gives my company.
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Hahaha, how pathetic. I knew it; ya got nothin'. Otherwise you could address the specific points that the article makes. Even with everybody paying taxes, happily or otherwise, these problems still have to be addressed.
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How would you know what normal people like?
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"Most normal people like plenty of things government does and happily pay taxes for the services government provides."
A statement that's refuted every April when millions of Americans take 100% of their available refund and/or Earned Income Credits. You'd think if they loved it so much they wouldn't even consider taking back that interest-free loan they gave Uncle Sugar, or take "earned income" that was earned by someone else.
I'd especially love to see empirical evidence of all these people who "love" paying their taxes, particularly when the annual home value assessments take place.
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Federal government rule rules!!!
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Give me my contributions back (not even asking for interest) for the last 40 years and I'll gladly take care of my old age needs myself. Maybe I'd actually be able to find a doctor (since increasing numbers are going to reject M/care and M/caid patients, whose reimbursements don't even cover the cost of completing the paperwork).
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"Mr. Obama, will this bill give my mommy health insurance?"
"No, Jimmy, it won't. But it will force her to buy health insurance from a government-approved provider or pay a tax--I mean, fee. And that's President Obama to you, fatty."
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Best comments I've read in a while---only had to change my panties from laughing, unfortunately libertarian ideals apparently lead to incontinence. Sign me up for the revolution anyhoo!
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Repeal the 17th!
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"Tax returns are the most obvious verification method, but tax returns reveal only what someone made last year. They don’t reflect the mid-year shifts that ObamaCare was intended to address, such as job losses that mean people can no longer obtain insurance through their employers and are newly eligible for subsidies. Yet states will have to create systems to account for such changes."
2 words:
anal probes -
I just heard New York State is imposing a 1.1% decrease in all medicaid payments as of 9/16.
I like the 36 hour notice, it makes it more classy that way.
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The democrats treat taxpayers like many restaurants treat their waitresses. Now matter how bad one waitress might be compared to an excellent waitress they split the tips evenly at the end of the day.
We should feel lucky progressives allow us to serve them and grateful for the scraps they throw our way to split up amongst our pissant selves. After all aren't taxpayers here to serve the progressive ruling class. It's only fair to the progressives that we split the tips they generously allow us with the other waitresses.
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Oh I don't know. I agree we should serve the progressives. Preferably well-done to avoid spreading parasites.
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Fuck!, some liberals get it, and don't view the private sector as one would greet the discovery of a long-dead raccoon under the crawlspace. Unfortunately, the ones in power are too weighted down with those kinds of extremists - and their cousins, the ones who view the private sector with mere disdain and only useful as a source of revenue to fuel their reelection machinery - i.e., welfare and other "entitlement" programs/voter bribery mechanisms.
Shit, even Fidel is getting the picture now, and here we are trying to follow in the footsteps he just recently described as a huge mistake.
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I see Class War rhetoric has made its' way to the mainstream. Robin Hood is not just a cartoon anymore, it's politics baby! Those fucking asshole rich mother fuckers giving people jobs and supplying us with stuff we like to use!!! KILL THE RICH. STOMP OUT THE BANKS!
Looks like the educated middle class in all of its academic glory has put the gloves on for the ol' helpless proletarian. Smash Capitalism!
Goodbye Rich man, you hard-working, self-made, risk-taking, job-providing, money-loaning asshole!!
I think the proles can handle it from here on out.
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The only class warfare being perpetrated is by the rich against the poor. Period.
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Was his name Sherif of Nottingham? Class War is gay dude. Having money kicks ass.... who gives a shit about poor people? Don't tell me that you do. haha.
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Its a bad hand we get dealt from either of these two corrupt parties. They've turned the government of the United States into nothing more than the very kind of oppression for which this country was founded to struggle against.
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It's the political version of Stephen Hawkin's "Arrow of Time". Corruption is simply a denotion of time moving forward rather than cyclical, stagnant or in reverse. All governments, regardless of their initial intent, and intended goals, will inevitably succumb to totalitarianism and oppression.
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I like the articles on this website, but why are the comments so vulgar?
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I'm hopeful re the challenges:
Commerce Clause: If govt can FORCE me to engage in commerce, what CANT it force me to do.
Mandate is a TAX and Feds have right to levy and collect taxes. The mandate does NOT meet the definition of the 3 types of tax Govt can levy. AND, tax must be for a revenue raising purpose, this "TAX" will be paid to insurance co's as a premium. -
ObamaCare desperastely needs to be repealed & replaced! Let's pray that happens.
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Why?
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Because it will raise premiums at an even faster rate, because it doesn't deal with tort reform, because it's unconstitutional, because he slammed it down the throat of an unwilling public. is that enough?
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So anybody who can't afford health insurance should just die?
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No, they should just not have health insurance.
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Because no one knows what is in it or whether it is even able to be implemented. Because it creats a monumental unfunded mandate. Becasue I said so.
All of the above!
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Very educated. So all government intervention and public services should come to a screaching halt?
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F' Obamacare. And I'll say it to his face, too.
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Wow, you're a badass. Why don't you throw a shoe at him too.
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Most states already have tort reform. And those people who did not have health insurance would have been treated anyway. And everyone who had health insurance would pay for it through higher premiums. So I say give the Health Care Reform Act a chance. I would go on, but I doubt many of you would believe me. It does not really matter what you believe, though.
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We must fight this tooth-and-nail or lose Freedom for good.
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One of the best breakdowns and history of this monstrosity I have ever seen. It should be required reading for those wanting to preserve the Republic.
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Good article, but it has a significant flaw. The PPACA does not provide federal subsidies through the exchange for most individuals between 0 - 133% FPL. If states drop Medicaid, most current Medicaid clients will not be eligible for exchange subsidies and would likely become uninsured.
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end
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