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The Health Care Law: Why’d He Do It?

Ten days ago, March 31, marked the end of registration for 2014 health care plans under the Affordable Car Act, i.e. “Obamacare.”  And while the deadline was fudged a bit by the administration, for all intents and purposes, the first year of Obamacare is now officially underway.  In light of this, we believe that now would be an opportune moment briefly to assess the law and to forecast some of its likely effects.

When the ACA was passed, nearly four years ago, it was presented principally as the culmination of nearly a century of Progressive struggle for the “human right” of universal health care.  Indeed, as the President signed the law he openly and proudly declared that he had just “enshrined . . . the core principle that everybody should have some basic security when it comes to their health care.”

The problem is that the ACA is not and never was intended to be a universal coverage mechanism.  Like so much else, security was promised, but will not be delivered.  A study by RAND Corporation suggests that only a quarter of Obamacare enrollees were previously uninsured.  And even if you add those few to the roughly 3 million new Medicaid enrollees, the percentage of the population that is uninsured is still higher than it was when Barack Obama became president.  Worse yet, the Congressional Budget Office recently estimated that some 31+ million Americans will still be uninsured in 2024, a full decade after the ACA’s implementation.

Now, the law’s supporters counter that the point of the ACA was not to sell more insurance but simply to expand coverage more generally.  And this goal, they argue, is being met in a variety of ways, including the Medicaid expansion, the extension of coverage on family plans to “children” up to age 26, and the elimination of the refusal of coverage for preexisting conditions.

Still the question remains: Why did the Obama administration decide to remake fully one-sixth of the American economy, when modest gains such as these could have been achieved with far less disruption?

Prior to the enactment of the ACA, most states already had high-risk insurance pools for residents with preexisting conditions.  Medicaid expansion could have been done more effectively and likely would have been better accepted if it had been enacted as a stand-alone law.  And the age-hike for family plans likely would have required no law at all, but merely an executive order.

We can’t say for sure, but based on the two lawsuits heard by the Supreme Court last week regarding the administration’s contraception mandate, we believe that the primary goal of the law was to achieve by regulatory means that which could not be achieved by legislative means, namely the advancement of the Obama-Progressive agenda.  Note that the mandate being fought by the likes of the Little Sisters of the Poor was not written into the ACA, but was advanced afterward via regulatory ruling by the Secretary of Health and Human Services, Kathleen Sebelius.  Note as well that regulatory interpretations by Obama officials are at the very heart of the ACA.  As Philip Klein wrote in the American Spectator roughly four years ago:

There are more than 2,500 references to the secretary of HHS in the health care law (in most cases she’s simply mentioned as “the Secretary”).  A further breakdown finds that there are more than 700 instances in which the Secretary is instructed that she “shall” do something, and more than 200 cases in which she “may” take some form of regulatory action if she chooses.  On 139 occasions, the law mentions decisions that the “Secretary determines.”  At times, the frequency of these mentions reaches comic heights.  For instance, one section of the law reads: “Each person to whom the Secretary provided information under subsection (d) shall report to the Secretary in such manner as the Secretary determines appropriate.”

What this means, then, is that a great deal of the Affordable Care Act is still unwritten.  Moreover, it will be “written” unilaterally by the Obama administration’s health care bureaucracy with the express intention of advancing Obama’s Progressive goals.  Many of those goals, we’re sure, would never pass legislative muster, just as many of them will clash with the values of countless Americans, especially religious Americans.

Four years ago, during the final debate over the ACA, then-Speaker of the House Nancy Pelosi declared that “we have to pass the bill so that you can find out what’s in it.”  What she meant, rather, was that they had to pass the bill so that the administration and its bureaucrats could tell what they wanted to put in it.