The slow-motion train wreck that is Obamacare crashed in Mississippi this month. Conservatives who have opposed the government makeover of health care have increasing evidence to say “we told you so.”
Even some honest liberals will stipulate that Obamacare is a model for how not to make policy. Now, Obamacare is showing how not to implement a law. On two fronts, the Obamacare drama playing out here mirrors the bumpy implementation of the President’s “signature” health care reform nationwide.
On February 8, the U.S. Department of Health and Human Services formally rejected Insurance Commissioner Mike Chaney’s “blueprint” for an insurance exchange. More recently, the Legislature has seen heated debate over expanding Medicaid to cover uninsured Mississippians up to 138% of the poverty level (bringing about 1 in 3 residents into Medicaid eligibility).
Obamacare was shoved through Congress with a set of unprecedented federal mandates (the individual mandate, er tax, being the most offensive). But much of the implementation is supposed to happen through states. And states are balking.
One key mechanism underpinning Obamacare is a “state-run” insurance exchange. States are to set up “market” exchanges, through which uninsured individuals can shop for insurance. The exchanges are also used to determine the amount of subsidy the government would offer to an exchange shopper, based on income. State-run exchanges are the vehicle through which employers would be fined for not offering “adequate” insurance to employees. (Or is it taxed? In the words of Hillary Clinton, “what difference does it make?”)
Think “free market” (which sounds good), but with all the flexibility of the IRS.
If a state does not set up an exchange acceptable to the federal government, Washington is empowered to step in. Many states are declining to set up exchanges, tossing the whole mess back to DC.
Here’s the rub: Obamacare did not appropriate money for federally-run exchanges. Washington is nowhere near ready to step in, even if HHS charges insurance companies user fees to foot the bill. And, the express language of the law allows the IRS to impose employer penalties only in states with state-run exchanges. Federally-run exchanges arguably do not have the authority to impose the penalties.
Sound like a mess? Welcome to liberal-utopia-dictated healthcare.
Governor Phil Bryant has opposed creation of an exchange, reasoning that it would not really be “state-run” and also that declining to create an exchange may well frustrate other parts of Obamacare, like the employer penalty. Commissioner Chaney has been moving in the opposite direction and working to create an exchange, arguing that it will be better for Mississippians to have an exchange run by Mississippians.
The disagreement between Bryant and Chaney has at times been public, and heated. DC has rejected Chaney’s efforts and will now step in, pulling the rug out from under Chaney’s position. When notified that HHS rejected Mississippi’s proposed exchange, Chaney stated that he felt “betrayed” and that he could no longer trust the feds’ intentions.
Bryant’s view that Washington will end up dictating exchanges appears to be accurate. It also seems apparent that Washington’s vision for the Obamacare exchanges is aimed more at funneling government subsidies and expanded Medicaid benefits to people, and collecting employer penalties, than at creating free market competition for insurance. States appear to have only the flexibility that Washington decides, which, as Bryant has stated, is no flexibility at all.
Speaking of Medicaid expansion, it appears headed for defeat in Mississippi. Governor Bryant opposes expansion because of the cost. Lt. Governor Reeves has said that
there are too many unknowns, including cost, to consider expansion. Speaker Gunn said last week that there are not enough votes in the House for expansion.
All this coincides with reauthorization of the state’s existing Medicaid program. Thanks to Democrat theatrics, expansion and reauthorization have become intertwined.
Democrats, who have never met an expansion of the welfare state they did not like, are not giving up yet. One Dem lawmaker urged Republicans to “think about the maimed.” Another actually stated that there were “too many Mississippi souls on the line” not to expand Medicaid. Dems must really think salvation comes through government.
Last week, those Democrats voted down reauthorization of existing Medicaid benefits without expansion, leaving the fate of the whole Medicaid program in limbo.
Funny, I have missed all the reporting accusing the Democrats of “taking hostages” and throwing granny off the cliff for voting against reauthorizing Medicaid. I guess those smears only apply when Republicans point out that even “federal dollars” (which are taxes taken from people by the government) cannot pay for an ever-expanding welfare state forever.
Cory T. Wilson is a Moss Point native and Madison attorney with Heidelberg Steinberger Colmer & Burrow, P.A. Follow Cory on Twitter, @CoryWilsonMS, or email email@example.com.