Obamacare Schadenfreude: Oklahoma Federal Court Says No

The big news of the day is that a Federal court in Oklahoma read the law, and decided that it meant what it plainly said: Oklahoma Federal Court Rules IRS Attempt to Save Obamacare's Subsidies for Federal Exchange Enrollees "Arbitrary, Capricious, an Abuse of Discretion, and Otherwise Not In Accordance with the Law"

This is the same issue as with Halbig vs. Sebelius Burwell, that the law as written only permits federal subsidies for state exchanges, not the federal exchanges. The law was clearly written that way to encourage the states make exchanges, but a majority of the states called their bluff and decided to let the feds carry the burden, and then the IRS decided to extend the subsidies to the Federal exchange anyway. At this point, the a D.C. Circuit Court panel found against the IRS in the Halbig decision (which is expected to go the to full court, where it will likely be overturned by Nukular Harry Reid's handpicked packees), while the 4th Circuit Court has sided with the IRS, claiming the actual words of the statute are irrelevant.

The Oklahoma Court also delivered a backhanded slap, as DWS might call it, to the notion that asserting the law means what is says is an inherently political act:

The court is aware that the stakes are higher in the case at bar than they might be in another case. The issue of consequences has been touched upon in the previous decisions discussed. Speaking of its decision to vacate the IRS Rule, the majority in Halbig stated "[w]e reach this conclusion, frankly, with reluctance." Other judges in similar litigation have cast the plaintiffs' argument in apocalyptic language. The first sentence of Judge Edwards' dissent in Halbig is as follows: "This case is about Appellants' not-so-veiled attempt to gut the Patient Protection and Affordable Care Act ('ACA')." Concurring in King, Judge Davis states that “[a]ppellants' approach would effectively destroy the statute . . . ." Further, "[w]hat [appellants] may not do is rely on our help to deny to millions of Americans desperately-needed health insurance."
. . . "
"Of course, a proper legal decision is not a matter of the court "helping" one side or the other. A lawsuit challenging a federal regulation is a commonplace occurrence in this country, not an affront to judicial dignity. A higher-profile case results in greater scrutiny of the decision, which is understandable and appropriate. "[H]igh as those stakes are, the principle of legislative supremacy that guides us is higher still. . . This limited role serves democratic interests by ensuring that policy is made by elected, politically accountable representatives, not by appointed life-tenured judges."

This is a case of statutory interpretation. "The text is what it is, no matter which side benefits." Such a case (even if affirmed on the inevitable appeal) does not "gut" or "destroy" anything. On the contrary, the court is upholding the Act as written.

It's time for the Supreme Court to actually decide this issue, I think.

And while I know that the court is not supposed to care what the public thinks (except for the case of gay marriage of course), they should be reminded that: 60 Percent of Voters Want Obamacare to Be Repealed

A new poll finds that three-fifths of likely voters support the repeal of Obamacare. A large plurality — 44 percent — wants to see Obamacare repealed and replaced with a conservative alternative. A much smaller group —16 percent — wants to see it repealed but not replaced. Less than one in three respondents — 32 percent — would like to keep Obamacare, whether in its current form or in amended form. So, with a conservative alternative in play, 60 percent of Americans support repeal, while only 32 percent oppose it.

And, just because the liberals on the court like to look to European examples to set their goals:
Swiss reject switch from private to state health insurance

Swiss voters on Sunday rejected a plan for a seismic shift from the country's all-private health insurance system to a state-run scheme.

Referendum results showed that almost 62 percent of voters had shot down a reform pushed by left-leaning parties which say the current private system is busting the budgets of ordinary residents.

The results also underlined the national divisions over the hotly-contested issue as the country's German-speaking regions voted against the plan, while their French-speaking counterparts were in favour.

Obamacare Spending, 73 Billion (with a "B") and still counting:

It’s hard to get a good accounting of what we’ve spent on the Affordable Care Act so far.
The Barack Obama administration has never really tried to count the cost of all the different elements and put them in one place. The Congressional Budget Office, meanwhile, has pretty much given up. Luckily, we have Bloomberg Government, my employer’s government intelligence service, which has thoughtfully totted up all the data it can glean from public records and come up with a figure for spending to date: $73 billion.

This number is both more and less than projected. BGOV puts spending on the enrollment website, for example, at around $2 billion, more than twice the cost offered by the administration. The difference comes from several factors:

1. Timing (the administration's figure stops at February, before a substantial outpouring of funds was made into cleanup work for the malfunctioning exchanges);
2. Inclusion of spending to get the IRS and other agencies ready for Obamacare;
3. Inclusion of the paper backup system, which proved so necessary during the rollout; and
4. Which contracts it chose to define as Obamacare-related.

On the other hand, the IRS has spent much less than it was projected to need (possibly because the work isn’t finished yet), and premium subsidies are, the report notes, off to a “slower than predicted start.”

Medicaid spending isn’t included in this estimate at all, because reliable data are not yet available. But if that comes in at around the $20 billion that has been predicted, the total price tag for the Affordable Care Act in its first years will end up approaching $100 billion.

A billion here, a hundred billion there, pretty soon you're talking about real money. And for what?

Under the ACA, the Doctor Won’t See You Now

Getting access to a preferred, in-network doctor is getting harder all the time. Three big stories about access blocks under the Affordable Care Act came out this week. First, the NYT profiles the troubling rise of contract ER doctors. The emergency medicine departments in many hospitals now employ doctors who are out-of-network for a given insurer, even when the ER itself is listed as “in-network” for that same insurer. The result is that even patients who have the ability to choose an ER in an in-network hospital often wind up with out-of-network doctors treating them—and large, unanticipated, out-of-pocket bills as a result:

When legislators in Texas demanded some data from insurers last year, they learned that up to half of the hospitals that participated with UnitedHealthcare, Humana and Blue Cross-Blue Shield — Texas’s three biggest insurers — had no in-network emergency room doctors. Out-of-network payments to emergency room physicians accounted for 40 to 70 percent of the money spent on emergency care at in-network hospitals, researchers with the Center for Public Policy Priorities in Austin found. [...]
When emergency medicine emerged as a specialty in the 1980s, almost all E.R. doctors were hospital employees who typically did not bill separately for their services. Today, 65 percent of hospitals contract out that function. And some emergency medicine staffing groups — many serve a large number of hospitals, either nationally or locally — opt out of all insurance plans.

The ACA does nothing to address this trend, which is just one example of the barriers to access popping up all across the U.S. health care system. The LA Times reports that, despite several lawsuits challenging it, California intends to stick with its narrow doctor networks for ACA plans next year. Even worse, some insurance companies are planning to cut the number of in-network providers even further. There is still no registry that would allow people to make a comprehensive assessment of which doctors will be covered under their ACA plans, a gap which caused a lot of confusion for patients in the last year.

Just more people with insurance competing for few, less well paid doctors; what could go wrong?

And just in from the old stomping grounds courstey of Wombat-socho's "Live at Five: 10.01.14":
Oregon pols battle over when to pull plug on costly ObamaCare website

Cover Oregon was supposed to be a shining example of ObamaCare at its best.

The state insurance exchange for the state of Oregon received $300 million in federal grants to launch a state-of-the-art website. But it never worked, and not a single Oregonian was able to sign up for health care from start to finish.

So now, Oregon is in the process of pulling the plug on the site and switching over to the federal exchange and HealthCare.gov -- but the question is, how quickly they can do it.

“We need to move forward and do the best thing for the people of Oregon,” Republican State Sen. Tim Knopp said, “and I think that’s ending Cover Oregon as soon as we practically can.”

Knopp and other Oregon Republicans are calling for a special session of the Legislature -- since lawmakers created Cover Oregon, only the Legislature can end it. But Democrats control the Legislature and the governor’s office, and they’re pushing back against Republicans' demand, and would rather wait until the 2015 session convenes in February to complete the transition.

“There are functions that still have to be performed by someone in the next few weeks and months,” Democratic state Sen. Richard Devlin said.

Inaction comes with a price tag.

According to Republican leaders, it costs taxpayers $200,000 a day to keep Cover Oregon running. Waiting until February 2015 or beyond will cost $20 million.

Hey, it's not my money anymore. Now I pay for Maryland's debacles.