On Thursday morning, governors John Kasich (R-OH) and John Hickenlooper (D-CO) released a plan to “stabilize” Obamacare insurance markets. Here’s what you need to know about the details of the proposal.
John Kasich Doesn’t Want to Repeal Obamacare
It’s worth repeating that, as recently as three years ago, Kasich said the following regarding the health care law: “From Day One, and up until today and into tomorrow, I do not support Obamacare. I never have, and I believe it should be repealed.”
Oh, how times have changed. The governors’ plan would not only not repeal Obamacare, it would further entrench the law, by giving tens of billions, and more likely hundreds of billions, of new taxpayer funds to wealthy insurance companies.
Governors Want Trump to Violate the Constitution
The plan calls on the Trump administration to “commit to making cost-sharing reduction payments.” But as this space has previously described, the United States has an interesting document—you may have heard of it—called the Constitution. That Constitution places the “power of the purse” with Congress, not the executive.
If Congress does appropriate funds—for cost-sharing reductions or anything else—the executive cannot refuse to spend that money, per a prior Supreme Court ruling. But if Congress does not appropriate funds, the executive cannot spend money. To do otherwise would violate a criminal statute.
Asking the Trump administration to violate the Constitution may seem like a natural request to someone like Kasich, a big-government liberal who ran into legal trouble for expanding his state’s Medicaid program unilaterally. But our nation is a government of laws, not men, which makes obeying the law an obligation of all citizens, let alone the chief executive.
A Selective History on Reinsurance
The blueprint cites Republicans’ proposed “stability funds” during the “repeal-and-replace” debate to suggest a “temporary” stability fund providing corporate welfare to insurers—demonstrating the lack of wisdom of the original congressional proposal. In addition to this “temporary” stability fund, the governors’ plan also claims that “the federal government has gone back on its commitment to these programs, in some cases refusing to fully fund [sic] risk sharing programs.” It goes on to propose that “Congress should modify and strengthen federal risk sharing mechanisms, including risk adjustments and reinsurance.”
The claims by the governors defy facts, particularly on reinsurance. The Government Accountability Office concluded last year that the Obama administration violated the law to give insurance companies billions more dollars in reinsurance funds than they deserved—prioritizing corporate welfare to insurers over statutorily required payments back to the U.S. Treasury.
But even after the Obama administration violated the law to give insurers billions more than they were due, the governors still feel the need to propose two separate “stability” (read: bailout) funds to prop up Obamacare. It demonstrates the massive “cash suck” that Obamacare has placed on the federal fisc.
An Impractical Proposal on Federal Employee Coverage
The plan also suggests that Congress should “allow residents in underserved counties”—defined as those with only one insurer on the exchange—“to buy into the federal employee benefit program, giving residents in rural counties access to the same health care as federal workers.”
This talking point—and it sounds like little more than a talking point—appears a solution in search of a problem, for several reasons. First, the Federal Employee Health Benefits Program (FEHBP) has very high premiums for federal workers, masked by massive federal subsidies. To provide some context, the Blue Cross Blue Shield Standard Option—the most popular option in FEHBP—has a monthly premium for 2017 of $709.93 for an individual. That total stands nearly 50 percent higher than the average $476 monthly premium paid by exchange participants this year. And the cost of a family plan for the Blue Cross Blue Shield Standard Option in FEHBP—$1,645.48 per month, or $19,745.76 annually—exceeds the cost of most cars.
FEHBP has such high premiums because it provides far richer benefits than the Obamacare exchanges. A 2009 Congressional Research Service report found that the Blue Cross Blue Shield standard option pays an average percentage of health expenses—in technical terms, the plan’s actuarial value—of 87 percent. By contrast, Obamacare links its insurance subsidies to the second-least-costly silver plan, which has an actuarial value of 70 percent.
Because the federal employee plan provides such generous coverage, opening it up to exchange customers would necessitate massive new increases in subsidies, which the governors’ plan also alludes to (“provide adequate and effective subsidies”). Combined with the reinsurance and cost-sharing reduction payments, it amounts to propping up Obamacare on taxpayers’ dime.
Millions of Americans found out in 2013 that when it comes to Obamacare, if you like your plan, you may not be able to keep it. But with respect to both Obamacare and the governors’ proposal, regardless of whether you like the plan, you’ll definitely be required to pay for it.