Obamacare

States Could Still Pursue ObamaCare Even If the Law Is Struck Down

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The Wall Street Journal reported recently that even if the health law is struck down by the Supreme Court, several states plan to move forward with implementing significant portions of the law anyway:

Officials in Rhode Island, California and Colorado—states where governors are broadly supportive of the law—say they plan to move ahead with their exchanges even if the entire law gets struck down. They added that they expect the law will remain in place, and are working to meet the 2014 deadline to get exchanges up and running.

"You can crystal-ball yourself to death," said Peter Lee, the executive director for the exchange in California. "If the unthinkable became thinkable, there are members of the state legislature, there's an exchange board, there are constituents across the state who would say, 'OK, now's the time to take the next steps.' "

Lawmakers in California have floated the idea of introducing a statewide requirement for individuals to carry insurance or pay a fee. Massachusetts is currently the only state to have this requirement.

The states wouldn't be able to rely on the federal funds afforded by the health law, but as California's flirtation with a Massachusetts-style state-based mandate suggests, they'd probably be able to replicate other parts of it. Indeed, there are no obvious legal barriers to following the Bay State's example in its entirety and enacting a state-based version of ObamaCare. 

Given the experience in Massachusetts, where officials remain deeply concerned about the mounting cost of health care under the law, I'm not sure why any state would choose to pursue that path. The point, however, is that a state that chose to could. This seems to undercut the arguments that the only alternative to ObamaCare is a national single payer system. It also suggests a way to experiment futher with the RomneyCare/ObamaCare approach without forcing on the entire country, which has remained consistently opposed to the law since before its passage. 

ObamaCare's advocates have made a big deal about the supposed flexibility the law gives to the states. But if this is correct, it appears that even without the law in place, states already have the flexibility to institute state-based versions of ObamaCare on their own. Granted, ObamaCare's backers were never serious about providing flexibility to the states (inititially many wanted a single federal exchange), and tended to highlight flexibility mostly as a response to resistance from state governments. But if there was ever any interest in providing real state flexibility, getting rid of the law and letting states decide whether or not to pursue similar reforms would be one way to do it.

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  1. Given the experience in Massachusetts, where officials remain deeply concerned about the mounting cost of health care under the law, I’m not sure why any state would choose to pursue that path.

    Sure you do. Because everyone is an idiot. And, because in 2010 the narrative had been laid out that something anything must be done about healthcare, the lazy state fucks are just going to go ahead with what the lobbyists wrote for Pelosi rather than get their own lobbyists to write something new.

    1. Which is why we’ll never see “Interstate commerce in health insurance is now open” as a federal law.

      1. Ive thought it amusing that due to federal law there is no interstate commerce in health insurance, yet the mandate is defended on ICC grounds.

  2. The states wouldn’t be able to rely on the federal funds afforded by the health law, but as California’s flirtation with a Massachusetts-style state-based mandate suggests, they’d probably be able to replicate other parts of it.

    Meanwhile, California is running more than a $25 billion budget deficit…

    http://www.latimes.com/news/local/budget/

    …and how much do we owe in unfunded pension liabilities?

    So, there are some practical limitations, here. It’s probably not a good time to buy a new Porsche.

    1. Meanwhile, California is running more than a $25 billion budget deficit…

      Kinda what I thought. Golden State pols seem to want to outdo James Cameron in seeing how deep they can go in as short a time as possible.

  3. Given the experience in Massachusetts, where officials remain deeply concerned about the mounting cost of health care under the law, I’m not sure why any state would choose to pursue that path.

    Because many politicians are quite happy to buy votes today at the price of fiscal catastrophe tomorrow.

    1. Because many politicians are quite happy to buy votes today at the price of fiscal catastrophe tomorrow.

      BINGO!

      1. You said it wrong. It’s “that’s a Bingo”!

    2. Because many politicians are quite happy to buy votes today at the price of fiscal catastrophe tomorrow.

      I’m Marion Barry, and I approve this message.

  4. “You can crystal-ball yourself to death,” said Peter Lee

    Sounds kinky.

  5. California is doing everything it can to send me, my company, my employees, and our millions in tax revenue to Nevada. It irresistible at this point.

  6. This will probably take care of itself over time.

    States that mandate coverage will see an exodus of healthy people and an inflow of high-risk health-cases, most with pre-existing conditions.

    This adverse selection problem will increase the cost of coverage until the system blows apart.

    So, in the long run, legislative idiocy is self-correcting (as long as the borders remain open).

    1. an inflow of high-risk health-cases, most with pre-existing conditions.

      Yes, isn’t this the reason Canada requires a much more thorough medical exam for immigration than it used to? As far as I know anyone with a preexisting condition or even a history of serious health problems will be rejected. It’s curious that all the Americans who claim to love Canadian Medicare also hate HMOs. I guess they don’t realize that most, if not all*, of the provincial plans are like HMOs on steroids.

      However, “an exodus of healthy people” does not seem to be one of Canada’s problems. It’s still a remarkably popular destination for immigrants and IIANM has an extremely low emigration rate.

      *Some provincial plans are more flush with money than others but they all contain costs by rationing and price controls. I’ve said before and I’ll say it now. Americans would not accept such a system if it were implemented. Not because they don’t want free unlimited medical care but because it’s not free and it’s not unlimited.

      1. However, “an exodus of healthy people” does not seem to be one of Canada’s problems. It’s still a remarkably popular destination for immigrants and IIANM has an extremely low emigration rate.

        For the time being, Canada still has a low enough population that it can absorb the extra costs associated with an increase in obligations. That will change if the population scales beyond the system’s ability to handle them.

        1. That’s probably why Canada’s immigration system gives preference to young, healthy, highly skilled, and hence high earning (they assume), individuals.

          It looks more and more like a plan to maximize revenues and minimize outlays.

        2. It’s also worth noting that over the years the provincial plans have been becoming stingier and stingier. Back in the sixities when the scheme was set up ther was something of a controversy over whether OHIP would cover chiropractic services. The Chiros finally won only to have coverage yanked in the 90s.

          Now to get you have to pay your own chiropractors bills or have your own or employer furnished supplemental insurance.

          And, of course, none of the provincial plans have ever had dental coverage.

          1. Delete that “to get” from the second para above.

          2. Also, whoops, my own link gives December 1, 2004 as the date when chiropractic services were disallowed not “the 90s”.

            Sorry about that. I think the 90s was when they started discussing removal. It’s always been controversial since many people do consider chiropractic quackery.

  7. Officials in Rhode Island, California and Colorado?states where governors are broadly supportive of the law

    Fuck John Hickenlooper in the ear with giant rubber dildo. When I first moved here, CO wasn’t too bad (socially moderate to slightly liberal/ relatively fiscally conservative), but it’s gotten progessively (pun intended) more and more TEAM BLUE as time goes on. I blame the college know-it-all hippies.

    1. When I first moved here, CO wasn’t too bad (socially moderate to slightly liberal/ relatively fiscally conservative), but it’s gotten progessively (pun intended) more and more TEAM BLUE as time goes on. I blame the college know-it-all hippies.

      It used to be that Colorado’s Team Blue craziness was confined to Boulder, the limosine libs in Eagle County, and Pat Schroeder’s district in Denver. It’s gotten ridiculous over the last 20 years as more and more refugees from blue-state hellholes have migrated there. Colorado will basically be in about 10 years what Vermont currently is.

      And yeah, fuck Hickenlooper–for this shit and for implementing LoDo’s stupid hipster culture.

  8. This is an interesting about-face, considering Suderman and the rest of the Reason crew have been arguing over and over again that implementing an insurance mandate at the state level “paves the way” for having one at the national level.

    Or maybe that’s a dog on the car roof that only barks once.

    1. Did the dog get up there because it was attracted by the barking roof?

  9. This is great news. Once you get a few of these idiot states to create their own mandated system, it basically blocks the Fed from coming up with a nationwide system. The Fed couldn’t force any state to scrap their already implemented program. If they try to exempt those states that already have a mandate system, they are admitting that individual states have the right to establish their own system. It then follows that a state also has the right to choose to not establish a system.

    1. So that means Mitt Romney actually PREVENTED Obamacare.

  10. Black Power

  11. You would think that, given California’s disastrous experience with politically created “exchanges” in energy, we would be at least a little gun-shy about politically created exchanges in “insurance,” lest a similar debacle ensue. Alas, you would be wrong.

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