Five lingering threats to ObamaCare

The White House’s victory at the Supreme Court last week removed a major threat to ObamaCare that could have rolled back coverage for 6.4 million people.

President Obama declared after the ruling that the law has “been woven into the fabric of America,” while allies said the new insurance program and its related policy changes are here to stay.

But the law is hardly out of the woods. The battle of public opinion over the Affordable Care Act rages on, with Republicans expressing confidence they will ultimately prevail.

Republicans are already turning their attention back to repealing the law, perhaps using a fast-track process called reconciliation that could move legislation through the Senate with just 51 votes.

But there are major obstacles ahead. Senate rules limit what parts of the law can be repealed using the process, and whatever legislation emerges would likely face a veto from Obama.

Facing long odds for success through reconciliation, many Republicans are pinning their hopes on the 2016 presidential election, when they hope their party will recapture the White House and control the legislative agenda.

But even if they won control of Congress and the White House, Republicans could find it difficult to get ObamaCare repeal past a Democratic filibuster in the Senate.

Under questioning from radio host Hugh Hewitt last week, presidential candidate Jeb Bush said he was open to the idea of curbing the filibuster to repeal ObamaCare.

Some of the 13 states that opted to set up ObamaCare marketplaces, known as exchanges, are considering turning over part of all of their operations to the federal government due to financial and technical problems.

New Mexico, Nevada, and Oregon have already handed over the toughest aspects of their operations to the federal IT system. Hawaii decided earlier this year to follow suit, and other states, including Vermont and Minnesota, are considering their options.

“The chances are good that some of the state-based marketplaces struggle, especially in the smaller states,” said Michael Adelberg, who formerly helped oversee the exchanges in the Obama administration and is now a consultant at FaegreBD.

The stakes of failing state exchanges are far lower now that the Supreme Court has ruled that subsidies can be made available on federal or state exchanges. But states have invested significant resources into their exchanges, with some costing as much as $200 million.

“We’re going to work with states that want to do state-based exchanges,” Health and Human Services Secretary Sylvia Mathews Burwell told reporters last week. “We’ll do federal exchanges where there aren’t those.”

Republicans have latched on to proposed 2016 premium increases of as much as 30 percent in some states to argue that costs are skyrocketing under ObamaCare.

States are likely to block any premium increases of that size, and the average premium increase appears to be trending at somewhere between 4 percent and 6 percent.

A Kaiser Family Foundation study found that in eleven cities with complete data so far, premiums are set to rise 4.4 percent, compared to 2 percent last year. Similarly, an analysis from Avalere Health, a consulting firm, found that premiums will rise 5.8 percent across eight states with complete data.

“The growth looks to be pretty modest,” said Larry Levitt, a vice president at the Kaiser Family Foundation, though “somewhat bigger this year than last year.”

Perhaps a bigger problem for the law is the cost of deductibles — the amount patients have to pay before insurance kicks in. A study from the Commonwealth Fund finds that 31 million people are “underinsured” because they face such high deductibles and out-of-pocket costs.

“Are the people buying lower cost plans in the Exchanges underinsured?” Adelberg said. “That is one place people are going to turn their attention.”

Expanding coverage is the main goal of ObamaCare, and the administration faces a daunting projection, set by the Congressional Budget Office, of 20 million sign-ups by 2016, up from 10.2 million currently.

Robust enrollment is important for creating the mix of healthy and sick that is needed to limit increases in premiums.

“The biggest challenge ahead is increasing enrollment. Getting more people signed up is central to the law's primary aim,” Levitt said. “Increasing enrollment is also key to keeping premiums under control.”

People who have signed up for ObamaCare so far tend to be sicker and poorer than the population at large. The challenge for the administration will be getting middle-income, healthier people enrolled. A higher penalty for lacking insurance next year (the greater of $695 or 2.5 percent of income) could help.

House Republicans have sued Obama over his handling of ObamaCare, citing executive overreach. They say he has spent money on the law’s cost-sharing reductions, which give money to insurers so that they can reduce deductibles and co-pays for low-income people, even though Congress declined to appropriate the money.

“It could have very serious ramifications because about 60 percent of ACA enrollees receive cost-sharing reductions,” said Tim Jost, a health law expert at Washington and Lee University.

The case is still in its early stages, and at the lowest level of federal courts. One court has yet to decide whether it will allow the case to go forward, given precedent saying that Congress does not have legal standing to sue the president. But at a hearing on a motion to dismiss the case last month, the judge levied tough questions at the Obama administration’s lawyer.

“I think next steps, whatever they are, really do need to include the ballot box and 2016 election,” Rep. Michael Burgess (R-Texas) said last week.

“Obviously, I don’t see any other court challenges coming in the next 18 months,” he added. “So we’re probably done with the court as a remedy.”

The origination lawsuit is still working its way through the DC Circuit Court.

I don't expect Roberts to overturn on this one either, because technically, the bill originated in the House and that will be his escape clause.

However, the true Constitutional issue is whether bills just act as numbered generic containers originating in either chamber, or whether "origination" includes the original content of the bill. Is a House bill, amended in the Senate to remove its title and all of its content and then replaced with entirely new Senate content, still considered a House-originated bill?

What's at stake is the plenary power of each chamber. The Senate has "advice and consent" and treaty ratification power that the House does not. The House has revenue origination and impeachment power that the Senate does not. If the Senate is allowed to gut an ordinary House bill with revenue content of its own making, then it has usurped a Constitutionally separated power of the House.

Roberts opened up this quagmire when he first legislated that the individual mandate penalty was a tax, something that nobody argued. In order to defend that decision, Robert now has to strip the House of its unique revenue origination power.

Mr. Balls and Strikes would be personally shredding the Constitution to pieces. My guess is that we'll never see Sissel v. United States Department of Health & Human Services leave the DC Circuit Court, just to protect Roberts' pretzel.

-PJ

: )

Here’s what the schemers have in mind for killing off conservative strength (the Left’s bench is empty and their local and state organizations aren’t supplying new socialist blood). So.......”fair vote.”

http://www.thespacereview.com/article/2779/1

“...........Population migration across the past few decades has re-colored the nation into blue urban districts and red rural districts, introducing a structural bias favoring Republicans even if up through 55% of the popular vote goes to Democrats. For the party in a district whose general election victory is all but a foregone conclusion, primary elections increasingly favor extreme candidates whose voters are more likely to turn out than moderates. With primary turnout declining to all-time lows in most states in 2014, it leaves this key power to our most partisan voters. Once in office, representatives feel loyalty pressure to vote along party lines, as the winner-take-all dynamic plays out even further. Consequently, these basic structural attributes happen to be conferring outsized power onto the far right.

........... A fair and elegant solution addresses the structural flaw through the creation of multi-member “super districts” assembled from, say, three to five adjacent single-member districts. A recent Washington Post editorial, “Blending red and blue,” concurs. With multi-member districts, the contentious issue of geographical district boundaries simply goes away because the district boundaries themselves go away.

A further structural refinement called Ranked Choice Voting (RCV) enables voters to elect their super district representatives as a group by ranking them in order of preference. RCV gets rid of the need to resort to strategic voting to game the two-party system and expands the power of voters elect a representative. With RCV voters simply vote their true preferences, thereby eliminating any fear of “spoiling” or vote splitting among similar candidates that may undesirably benefit a dissimilar candidate. Every vote counts, and voters are no longer constrained by where they live but are free to engage by how they think. FairVote has created an excellent infographic and website that help explain multi-member districts and RCV.

Many city governments in the United States, including Minneapolis, San Francisco, and Oakland, have already successfully implemented RCV. Meanwhile, Maine will hold a referendum next year to adopt RCV for all congressional and state elections.

Multi-member districts and RCV find broad support among both progressives and conservatives. See, for example the recent article by self-identified conservative and National Review writer Reihan Salam, “The Biggest Problem in American Politics: Forget gerrymandering. Here’s what we need to fix to ensure truly fair elections.” And the recent op-ed by self-identified progressive Katrina vanden Heuvel of the Nation magazine, “We Need a Fairer System for Choosing House Members.”.............................

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.