When ObamaCare Becomes NanoCare

I bet you didn't see this one coming: the Affordable Care Act is not going to be covering nearly as many people as originally thought. Since it was passed on the assumption that employers would be purchasing much of the mandated private insurance for workers, and millions of jobs have been and continue to be lost, the Congressional Budget Office now estimates that two million fewer people will be covered by 2016. More than 27 million Americans will still be uninsured four years from now. That is, if the Supreme Court rules favorably on the constitutionality of forcing people to purchase products from private vendors. 

In theory, this revised government estimate should make the deficit hawk critics happy -- since so many people will be getting thrown under the bus, it will also cost about $50 billion less than originally thought, too. People not getting the medical care they need will actually help balance the federal budget. Hooray for austerity!

But not to worry, says the CBO -- more people than ever will be eligible for the state-administered Medicaid programs because poverty is going up, up, up. So if you live in a state like Texas, which hopes to opt out of Medicaid entirely, you might want to think about emigrating.

Still, the CBO report goes on, the number of employers expected to pay penalties for noncompliance with the law is expected to increase, as are the individuals having to pay fines because they lack insurance. (That part is confusing. I am guessing that after the uninsured pay their fines, they can then qualify for Medicaid. Eligibility requirements for Medicaid are supposed to be looser once the law kicks in. And meanwhile, the Obama Administration is gifting Scrooge employers like WalMart and McDonalds with waiver after waiver after waiver. What an unholy mess). 

The CBO, to its nonpartisan credit, also takes note that American wages continue to stagnate. Therefore more children of struggling parents than expected will be eligible for the government-subsidized CHIP program. The CBO simply hadn't dreamed that one in four American children would be thrust below the poverty level when they started crunching their numbers two years ago in Obama's misguided effort to make his delayed health care plan deficit-neutral.

Julian Pecquet of The Hill offers a summary: 

The combined effects of the revised estimates over the 2012–2021 period add up to:

■ An increase of $168 billion in projected outlays for Medicaid and CHIP;

■ A decrease of $97 billion in projected costs for exchange subsidies and related spending;

■ A decrease of $20 billion in the cost of tax credits for small employers; and

■ An additional $99 billion in net deficit reductions from penalty payments, the excise tax on high-premium insurance plans, and other effects on tax revenues and outlay, with most of those effects reflecting changes in revenues.

As I laid out in a previous post, the Supreme Court will hear arguments on the individual mandate in less than two weeks. The libertarian Koch Brothers are transporting busloads of "Keep Your Hands Off My Healthcare" astroturfers to demonstrate against the ACA, and the Obama administration is "facilitating" counter-demonstrations, even prayer vigils, to keep its behemoth of a signature accomplishment alive. Now that the CBO has estimated that the law is becoming ever more unwieldy because of the reality of the crappy economy, will the Court be that much more inclined to strike down the individual mandate? Without the provision that we all be forced to buy policies from insurance leeches, the whole law is kaput.

Obama blew it when he abandoned the single payer option. If he had really wanted to, he could have forced it through Congress via the reconciliation tactic.  So, while a declaration of unconstitutionality may be a blow to those lucky few people now benefiting from the measure, it will be a blessing in disguise to most of us. Almost two-thirds of those polled have expressed a preference for a Medicare for All program.

As former Labor Sec. Robert Reich puts it when making the case for Single Payer, nobody from either left or right would object to a payroll tax deduction, which is how it would be paid for. No court has ever struck down a payroll tax as being unconstitutional. Reich says:

Other federal judges in district courts - one in Virginia and another in Florida - have struck down the (ACA) law on similar grounds. They said the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy broccoli or asparagus. (The Florida judge referred to broccoli, the Virginia judge to asparagus.) Social Security and Medicare aren't broccoli or asparagus. They're as American as hot dogs and apple pie.