Tuesday, July 1, 2014

Obamacare Schadenfreude - Hobby Lobby Wins, Obama Loses

There's a lot of digits being spent of this, but I suggest you read Ann Althouse's summary:
. . . The Court found a substantial burden to the religion of the owners of the businesses in being required to facilitate what they see as abortions or to pay fines that could be as "as much as $1.3 million per day, or about $475 million per year, in the case of one of the companies."

Under the statute (RFRA), that substantial burden triggers strict scrutiny, and the Court assumes for the purpose of the opinion that the HHS regulations have a compelling interest, because is so easy to say: Even if the interest is compelling, HHS hasn't used the least restrictive means for serving it.

HHS has already put into place a system for contraceptive coverage for religious nonprofit corporations, and it gave "no reason why the same system cannot be made available when the owners of for-profit corporations have similar religious objections."
. . .
If HHS would just give the religious for-profit corporations the same accommodation it already gives to the nonprofit religious corporations, the effect on women employees "would be precisely zero."
Less rigorous, but more fun, you might also enjoy Ace's take:
It occurs to me that the Left is attempting to create a system wherein there are two different classes of citizenship, one fully possessed of its right to speak and act politically, the other whose rights in this regard are sharply curtailed.

That's obvious, that's not the interesting part.

Here's the interesting part, I think: The Left, were it to have its way, would forbid anyone who is not primarily in the business of politics (or working for the government or university) from exercising their full political rights.

If you work in any other industry, your rights are substantially reduced.
Think how much this proposed rule would benefit the Left, were it fully accepted. (It is 85% accepted at the moment.)

The only people who would be permitted to speak on political issues, or at in accordance with their social/cultural/religious/political principles, would be the Political Class Itself, which is of course largely "progressive."

Shopkeeper? Nope, you're not a professional of the political class. Shut up. You have no right to run your business asyour conscience dictates.

Baker? You're not a professional in the political class. Shut up and bake the cake.
And so on. By choosing an economically-productive trade which is not politics, you have ceded most of your rights in the political sphere, per this line of thinking.

The people who retain their full rights are the artists, the academics, the media class, the union officials, the teachers and other civil servants, and all the various functionaries of the permanent DC lobbying/think tank class.
There is one more:  I WAS RIGHT ABOUT THE ACA
Below I will resurrect but five of my own specific predictions about the ACA, contrast them with what many advocates had said, and review what subsequent events have shown.
#1: States will make a variety of decisions with respect to expanding Medicaid.

What I predicted: “In contrast with some statements made by both supporters and opponents of the ACA, the complexities of these decisions suggest that states should be expected to make a wide variety of policy choices.”

Advocates’ claims: “All these states will opt in. Every one.” (Jennifer Granholm) . . .

What has happened: As of June, 2014, the Kaiser Family Foundation lists 27 states (including Washington, D.C.) as “implementing expansion,” 21 as “not moving forward at this time,” and 3 in “open debate.”

#2: Expanding Medicaid will cost the states money, in part because of the “woodwork effect.”

What I predicted: “Projections indicate that... covering newly eligible individuals as well as increased numbers of those previously eligible (but yet uncovered) would add substantially to state budget costs. Effective (federal support) rates associated with expansion will be lower than those expressly provided for in the ACA because of the ‘woodwork effect’ of previously eligible individuals being brought under Medicaid.”

Advocates’ claim: ...The move to greater insurance coverage would likely result in substantial savings for state and local governments. Rather than harming the budget situation of the states, health insurance reform would improve it.” (CEA, Obama White House)

What has happened: “At least a couple of states have already cited higher-than-expected costs... This graph from a December 2012 NASBO report shows how Medicaid has been taking a greater portion of state general funds, while education spending has decreased.”

#3: The ACA will significantly worsen the federal budget deficit.

What I predicted: “The Affordable Care Act (ACA) enacted in 2010 will significantly worsen the federal government’s fiscal position relative to previous law...

Advocates’ claim: “According to the official Administration and Congressional scorekeepers, the Affordable Care Act will reduce the deficit: its costs are more than fully paid for.” (White House Blog)

What has happened: Two months after my study was published, CBO’s next long-term budget outlook clarified explicitly that I was correct: CBO’s baseline comparison that appeared to show the ACA reducing the deficit did not reflect how it changed actual law: “Projections in this report are consistent with a statutory requirement that CBO, in its baseline projections, assume that benefit payments will continue to be made after trust funds have been exhausted, even if there is no legal authority to make such payments.”

#4: Expanding health insurance coverage will increase health service consumption and costs.

What I predicted: “The same report found that the uninsured received only about 55 percent of the total medical care received by the insured population and that, if covered, per-person health spending for the uninsured would increase by 39 percent...

Advocates’ claim: “It is deficit-neutral; it bends the cost curve; it covers 30 million Americans who don't have health insurance... to make sure that people are getting the care they need and the checkups they need and the screenings they need before they get sick—which will save all of us money and reduce pressures on emergency rooms all across the country.” (President Obama)

What has happened: “As the health-care law expands Medicaid to cover millions more Americans, a new Harvard University study finds that enrollment... significantly increases enrollees' use of emergency departments.”

#5: There was a substantial risk that cost savings projected for several ACA provisions would not fully materialize.

What I predicted: “The legislation employs comparatively uncertain cost-saving measures as budgetary offsets for comparatively certain cost-increasing provisions... The proceeds of such cost-savings cannot safely be spent until they have verifiably accrued.”

Advocates’ claims: “$750 billion in reliable revenues and savings... $145 billion saved... by phasing out overpayments to... Medicare Advantage... $69 billion in penalties paid by employers and individuals who choose not to purchase insurance... $32 billion raised by taxing very expensive (“Cadillac”) health insurance policies...

What has happened: The employer and individual mandates have not been enforced and there is mounting pressure for repeal. Planned Medicare Advantage cuts have been scaled back. The Cadillac plan tax has not yet taken effect and labor unions are mobilizing against its implementation.
. . .
While we cannot erase past policy mistakes, going forward we should make better use of predictive information widely available to lawmakers, press and public, than was done in the case of the ACA.
These same points have been made time and time again in Obamacare Schadenfreude posts.

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