At a conference of state legislators and health officials this week, Health and Human Services Secretary Kathleen Sebelius chided Republicans for their continued opposition to Obamacare. "This is no longer a political debate; this is what we call the law," she said, according to CBS Atlanta. "It was passed and signed three years ago. It was upheld by the Supreme Court a year ago. The president was re-elected. This is the law of the land."
That's rich, given the administration's recent track record. Sebelius and her colleagues in the White House may not like that Republicans are not eagerly lining up to assist the White House implement a law that they have always opposed. But their major forms of opposition—declining to expand state-based Medicaid programs, refusing to build state-run health care exchanges, saying mean things about the law—are all perfectly legal. This is true even if you think they are not serving the public, are not behaving with dignity, or are simply very bad people. The law, in combination with the Supreme Court's Medicaid ruling last summer, gives Republican governors the ability to opt out of creating their own exchanges, and allows them to keep their current Medicaid programs without fear of penalty.
It is the Obama administration which has chosen to ignore the law of the land by selectively enforcing provisions, encouraging government agencies and ignoring clear legislative language that conflicts with the administration's goals. The administration's delay of the employer mandate, for example, is not supported by statute. And when questioned about his administration's authority to enact the delay, Obama has not even tried to claim that it is; instead he has simply asserted the authority to delay the provision, and then returned to criticizing Republican opposition. When Republicans in the House voted to give Obama explicit authority to delay the provision, and to delay the individual mandate as well, he issued a veto threat.
There have been other delays as well, on the income and health status verification requirements for state-based exchanges, on the out of pocket caps for insurance.
In response to a provision in the law requiring congressional legislators and their staffers to buy insurance through the law's exchanges, meanwhile, President Obama personally lobbied the Office of Personnel Management to rule that those employees could use their federal employer health benefit contributions toward the purchase of exchange-based coverage. But OPM has no authority to fund coverage not contracted through the federal benefits program.
And then there is the matter of the law's insurance subsidies. The text of the law states only that these subsidies are available in exchanges created by states. Yet the administration has embraced a ruling by the Internal Revenue Service that allows the subsidies in the 34 exchanges run by the federal government.
Does the Obama administration believe that Obamacare is the law of the land—or that the law of the land is whatever the Obama administration says it is?