In 2014, Obamacare took effect. That year Line 61 in the “Other Taxes” section of our beloved 1040 tax form began to read: “61 Health care: individual responsibility (see instructions) Full-year coverage,” followed by a box to check if you had health insurance for the entire year and a space to enter the amount you owed if you didn’t. That line hadn’t appeared on the 1040 for 2013, nor on any prior 1040.
In “Health Insurance Coverage of the Total Population” at the Kaiser Family Foundation, we see the percentages of Americans in insurance categories and what they were in 2013 and in 2015. “Non-Group” is the individual market, which has been taken over by the Obamacare exchanges and Healthcare.gov. “Other Public” is mainly military, the Veterans Affairs. Here, then, are the percentages by category in 2013, the year before the ACA took effect, and in 2015:
Of the non-military categories, those who bought insurance in the individual market (Non-Group) were by far the smallest category in 2013. Although it’s still the smallest such category, the individual market has had the largest percentage growth. Non-Group enrollees grew from 13.8 million to 21.8 million. The next largest percentage growth of the non-military categories was for Medicaid, and its numbers went from 54.9 million to 62.3 million.
It Was Really the Medicaid Expansion Act
In “The Future of the Affordable Care Act” at the JAMA Network in August 2016, Stuart M. Butler writes that “the ACA might be more appropriately labeled the ‘Medicaid Expansion Act’ [because] enrollment in the ACA exchanges [i.e. Non-Group] has been disappointing, with an estimated 10 million fewer people enrolled compared with earlier projections.”
And Non-Group is not the same group it was. In 2013, the category consisted of those who paid the full price for their health insurance, but now the category also consists of those receiving federal subsidies to buy that insurance. Most of the new enrollees are only paying part of the price, as 8 in 10 receive tax credits.
The final numbers for 2016 may not be available yet, but in a study released in September 2016 by the National Center for Health Statistics, we read: “In the first 3 months of 2016, 27.3 million (8.6%) persons of all ages were uninsured.” That contrasts with the 41.7 million uninsured persons in 2013.
Democrats took over the nation’s entire health-care system for the sake of less than 5 percent of us. Democrats often say that health care is a “right.” But Obamacare didn’t even halve the number of uninsured in America. What about the “rights” of the 27.3 million Americans who still have no health insurance?
Making Everyone Pay for Everything Is Expensive
Of the five insured categories in 2013, three were public, i.e. run by government, and two were private. But now government has intruded itself further into private-sector health care, not only by creating public subsidies to buy private health insurance, but also by dictating what private insurance policies must cover. All new health insurance policies sold in America must be Obamacare-compliant, and cover every conceivable condition, which has made insurance more expensive.
In July of 2016, Forbes ran “Overwhelming Evidence That Obamacare Caused Premiums To Increase Substantially” by Brian Blase of the Mercatus Center: “S&P Global Institute found that average individual market medical costs increased substantially between 2013 and 2015, up an estimated 69%. […] Instead we see adverse selection in the individual market, with spiraling premiums, sizeable insurer exits, and enrollees generally attracted to ACA plans only if they are either highly subsidized or relatively old or unhealthy.”
Obamacare is a basket case, requiring constant infusions of more funds, as in the “risk corridor” bailouts of the insurance companies, and the bailouts for policyholders who can’t pay their deductibles. Even so, Republicans in Congress often seem to lack the wherewithal to replace it, (maybe they’re thinking about reelection). But there is one change the GOP must get done, and it involves what was the issue back in 2009 when the ACA was being debated: the mandates. Whether in a stand-alone bill or in some “comprehensive” replacement for Obamacare: the individual and business mandates must be repealed.
The Mandates Should Be First to Go
Repeal of the mandates in this session, preferably in 2017, is a bottom line. If the mandates are not repealed, it would be a serious betrayal of voters, and grounds for mounting primary challenges to incumbents. DC politicians don’t seem to grasp that the mandates, as originally conceived, are fascistic. Justice John Roberts seemed to understand that in NFIB v. Sebelius when he wrote that the Commerce Clause doesn’t allow Congress to command Americans to buy things. But then he concluded that the command (i.e., mandate) was really an option, and that the penalty was really a tax, thus saving Obamacare (while creating a whole new chapter in American jurisprudential incoherence).
If the mandates are repealed, many young folks will opt to go without health insurance. But that can be a rational decision. A young person wishing to amass funds to buy a house, or start a family or a business might decide that taking the risk of having no health insurance is worth it. Maybe youngsters would decide differently if health insurance weren’t so damned expensive.
But why is government insurance so expensive? One of the reasons is fraud. On July 2, National Review ran “The Great American Rip-Off,” a terrific article by Kevin Williamson that turns a cold eye on entitlement fraud. Another reason might be the cost of care itself.
If you were in an industry that had a customer base that was 91 percent of the population, and the government accounted for much of your income and provided payments that were automatic and not limited by budget, and your private-sector customers were coerced into buying insurance that paid for your products whether they needed them or not, then, with assured streams of revenue like that, you might charge whatever you thought you could get. After all, you’re improving folks’ lives; even saving them. Besides, you got that huge student debt to pay off, and your malpractice insurance to pay, and your support staff to pay, and all that new technology to pay for. Hell’s bells, you need to jack up prices again.
Democrats speak of repealing Obamacare as though it would be some monstrous crime against Americans. But we’ve only had Obamacare for three and a half years; was our situation intolerable back in 2013? We still have millions of citizens without insurance coverage, prices are still rising sharply, some folks can’t afford to use their ACA insurance because of their high deductibles, and the deficit is going the wrong direction again. Now, what’s so wonderful about Obamacare?
What the Dems are really concerned about is the embarrassment they’d suffer were the GOP to succeed. If Republicans actually created a system that cost less and was less coercive and covered everybody, Democrats’ mendacity in passing Obamacare would stand out in high relief. But then the IRS could simplify our taxes a bit: by deleting Line 61 on our beloved 1040s. Yippee!