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The Right Prescription
The States Fight in the Last Ditch Against Obamacare
They could still win if their leaders have the courage to stick to their guns.
Last July, I wrote that the states still had the power to kill Obamacare, despite the Supreme Court’s gross dereliction of duty in Florida v. HHS. My point was that the insurance exchanges required by PPACA are the key to its success or failure, and that the law grants the states enormous power in the way they are set up. The ostensible purpose of these exchanges is to provide “marketplaces” where people without health insurance can acquire subsidized coverage. Ironically, the law doesn’t actually require states to set up these bureaucracies. Yet, as Sally Pipes and Hal Scherz note, “only state-based exchanges … may distribute credits and subsidies.”
In other words, if the states refuse to set up exchanges, they cut off the subsidies and tax credits that are the lifeblood of Obamacare. Moreover, states that decline to set up these enabling bureaucracies will also be protecting their business communities from job-killing federal penalties — even if the federal government comes in and sets up its own exchanges in those states. The Cato Institute’s Michael Cannon explains, “defaulting to a federal exchange exempts a state’s employers from the employer mandate — a tax of $2,000 per worker per year.” This is why more than half of the 50 have opted not to set up state-run exchanges.
Last Friday, three more governors officially announced their refusal to set up state-run Obamacare exchanges. Ohio’s John Kasich, Wisconsin’s Scott Walker, and Maine’s Paul LePage all released statements indicating that they would not assist the Obama administration in its effort to socialize health care in their states. All three governors made their decisions based on the knowledge that, even if they cooperate on the exchanges, they would have little control over how the exchanges are operated. As Cato’s Cannon puts it, “[A] state-created exchange is not a state-controlled exchange. All exchanges will be controlled by Washington.”
In fact, the grim reality is that Washington won’t be content to merely control the exchanges. Federal bureaucrats have already begun rewriting the law when the provisions of the actual statute prove inconvenient. When it became obvious that many states would refuse to create exchanges, the Obama administration decided to funnel tax credits and subsidies through federally-created exchanges, ignoring clear language in the law indicating that such premium-assistance was restricted to state-run exchanges. The IRS recently finalized a regulation signaling its intention to illegally provide premium assistance through federal exchanges.
This outrage prompted the state of Oklahoma to file an amended complaint in the U.S. District Court for the Eastern District of Oklahoma. The state points out that “The State of Oklahoma has exercised its right not to establish an Exchange” and that the provisions of ObamaCare “not only permit the State of Oklahoma to make this policy choice, but also created a mechanism … by which the State of Oklahoma can put its decision into effect.” It goes on to show that “The [IRS] Final Rule renders the mechanism inoperative.” In other words, Oklahoma complied with the provisions of the law and now the IRS has illegally ignored those provisions.
Will the Oklahoma lawsuit go anywhere? The June Supreme Court decision on Obamacare, regardless of its surreal aspects, actually offers some hope here. Although the majority in that ruling disappointed many where the individual mandate was concerned, it nonetheless ruled in favor of the plaintiffs on the Medicaid mandate, which the plaintiffs said “commandeered” state authority. This, as it happens, is precisely the reasoning used by Oklahoma regarding the IRS Rule: “[It] commandeers state governmental authority with respect to State Exchanges, permits HHS to exercise a State’s legislative and/or executive power.”
Meanwhile, HHS has decided to extend the deadline for state governments to declare whether or not they will set up state-based exchanges. The original deadline by which states were to declare their intentions was November 16. Now Kathleen the Terrible has condescended to give them until December 14. The HHS secretary says the extension was prompted by a desire to provide the states with “the flexibility, resources, and technical assistance necessary to help you achieve successful implementation of your state’s Exchange.” More likely, she wants more time for the arm-twisting and legal skullduggery for which she is justly notorious.
Inside the Beltway, Republicans seem prepared to wave the white flag on Obamacare. Shortly following the election debacle, House Speaker John Boehner declared that “Obamacare is the law of the land.” The tsunami of criticism he received pursuant to that ill-considered remark is probably behind the effusive praise he heaped on John Kasich for his decision to opt out of a state-run exchange for Ohio: “I’m proud of my governor for taking a stand and resisting the federal takeover of healthcare in Ohio.” And, regardless of Boehner’s sincerity or lack thereof, the states are probably our last hope of getting rid of this big-government boondoggle.
So, the long twilight struggle continues. Without its insurance exchanges, the Obamacare scheme simply will not work, but the states are fighting in the last ditch against an increasingly powerful and lawless federal government determined to foist them on us. If the states are bullied into setting up their own exchanges or the IRS gets away with its extralegal rule to fund federal exchanges, we’re probably stuck with it. Speaker Boehner’s bleak post-election assessment will have been correct after all.
About the Author
David Catron is a health care revenue cycle expert who has spent more than twenty years working for and consulting with hospitals and medical practices. He has an MBA from the University of Georgia and blogs at Health Care BS.
ScaredStiff| 11.19.12 @ 6:50AM
How many states have to opt out for us to be successful at getting rid of this thing? Thankfully our governor, Scott Walker, saw the handwriting on the wall. How many others have to follow suit?
Purp| 11.19.12 @ 11:46AM
You can't... Like Lindsay Graham says "when you're in a hole, stop digging"
You won't stop it, so enjoy it.
CJW| 11.19.12 @ 5:49PM
Purp the Village Idiot posted the following after the elections:
"Purp| 11.8.12 @ 10:35AM
"The Lord rules, not Obama." - CORRECT!
The Lord works in mysterious ways... and this is something for the faithful to contemplate in the way the see the world:
Hurricane Sandy and Chris Christie was the Lord's way of pressing his thumb on the scale to tilt in the direction of President Obama. It was His punishment of Republicans for their lying and trying to cheat (Voter Suppression) their way to political victory, while espousing faith, freedom and constitutional credentials."
So purpie believes God killed over 100 persons and destroyed millions of dollars of property to help Obama win.
In Sept Purpie wrote that Amassador Stevens was at fault and caused his death.
Purpie also wrote that the unborn are biological entities not deserving of protection until God allows them to be born. (What does this mean?)
Purpie represents the Loon Left that should be mocked and ridiculed, and not engaged in conversation
Bill Hussein O'Stalin| 11.19.12 @ 7:02AM
Since employers who exists in states without state exchanges would be exempt from the employer mandate, expect those states to see a huge pick up in employment. Perhaps many companies will move from the state exchange states to the states with the federal exchange.
Another side effect is that free loaders will move to the states with the state exchanges while avoiding the states with the federal exchanges.
It looks like a win-win for the states who refuse to go along with Obamacare.
Von Mises Jr| 11.19.12 @ 7:42AM
Also the States are exempt from expanding the Medicaid to 138% of the poverty line. Rick Scott wrote an article at TAS a few months ago refusing to incur the $2B annual cost.
Since Medicaid is mostly funded by the State Property taxes, besides States that opt out attracting businesses, they will also attract freedom loving people to their states.
If Christie in New Jersey implements the Exchange and expands Medicaid, the American Association of Physicians and Surgeons calculate a $5B increase in the State Budget. This would increase Property Taxes by as much as 15-20%. So it makes sense to sell in NJ and buy in FL. Over time, NJ will have less people to fund more government. Can you say implosion?
But FL, OH, AL, IN and other States with Governors that refuse both Mandates will see their populations increase while State Budgets remain lower.
We can have Federalism in these States with more companies, more people and a home for private insurance companies.
Al Adab| 11.19.12 @ 10:44AM
Let us all watch and hope that other States will follow suit. Courage has many names, but defiance of tyranny is one of then. Non-compliance by the States and by individuals who will not bow to the mandate is perhaps the last bastion of our Liberty.
You are right Jr. in noting that the States which refuse will see their economies expand while those which submit will suffer greatly.
Von Mises Jr| 11.19.12 @ 11:02AM
Do you know any liberals that want to buy a nice house in a socialist state? I'm willing to negotiate.
Purp| 11.19.12 @ 11:49AM
Another right wing fantasy ... if the States don't set up an exchange, the Federal Govt will. So they make it even more probable it's run by the Federals... how stupid.
CJW| 11.19.12 @ 5:29PM
Purp the Village Idiot posted the following after the elections:
"Purp| 11.8.12 @ 10:35AM
"The Lord rules, not Obama." - CORRECT!
The Lord works in mysterious ways... and this is something for the faithful to contemplate in the way the see the world:
Hurricane Sandy and Chris Christie was the Lord's way of pressing his thumb on the scale to tilt in the direction of President Obama. It was His punishment of Republicans for their lying and trying to cheat (Voter Suppression) their way to political victory, while espousing faith, freedom and constitutional credentials."
So purpie believes God killed over 100 persons and destroyed millions of dollars of property to help Obama win.
In Sept Purpie wrote that Amassador Stevens was at fault and caused his death.
Purpie also wrote that the unborn are biological entities not deserving of protection until God allows them to be born. (What does this mean?)
Purpie represents the Loon Left that should be mocked and ridiculed, and not engaged in conversation.
Purp| 11.19.12 @ 11:48AM
How dumb - if the States don't set up their own, the Federal Government will - and the State will have given up it's rights to run a thing. How stupid can they be to make a point?
Bill Hussein O'Stalin| 11.19.12 @ 12:32PM
You're apparently revel in being a moron. You missed the part about the states opting out so the federal government picks up the cost. That means ever more of a burden for the blue states and the red states citizens get a freebie. Pretty funny ending to another tragedy that starts and ends with liberalism.
http://spectator.org/archives/.....tcontainer
In other words, if the states refuse to set up exchanges, they cut off the subsidies and tax credits that are the lifeblood of Obamacare. Moreover, states that decline to set up these enabling bureaucracies will also be protecting their business communities from job-killing federal penalties -- even if the federal government comes in and sets up its own exchanges in those states. The Cato Institute's Michael Cannon explains, "defaulting to a federal exchange exempts a state's employers from the employer mandate -- a tax of $2,000 per worker per year." This is why more than half of the 50 have opted not to set up state-run exchanges.
Purp| 11.19.12 @ 3:10PM
We'll see. Social Security was limited when it was first implemented ... so good luck with that, since the Red States suck more from the Feds than the Blues do. Ya think they'll sit back and watch the people in the Blue States get healthcare, while they don't? Blue South, anyone? Hahaha
Drunken Sailor| 11.19.12 @ 4:24PM
Love that argument. Break it down in federal aid per capita and see what you get. You get a totally different picture then.
Purp| 11.19.12 @ 9:37PM
That has no bearing on the argument. It's the typical right wing spin to make it seem to their favor. It's the total going to and from the State that matters.
Case in point : If my employer pays me 100k/year and I have 2 kids and my neighbor gets 100k/year from the same employer for the same job - but he has 100 kids, then PER CAPITA, he makes less than I do ... but that is a false comparison. The Employer still has 2 100k paychecks he's paying out. Doesn't matter how the money is apportioned or gathered.
In total, combining all the Blue States and all the Red States shows that the Federal money flows more to the Red States (the takers and moochers) from the Feds than the Red States pay to the Feds. The Blue States pay far more to the Federal Govt than they get back from the Feds.
Conclusion: The Red States are the biggest takers and moochers in the Nation. And they don't even know it. Must be Fox News viewers, huh?
Gary B| 11.19.12 @ 8:22AM
"Inside the Beltway, Republicans seem prepared to wave the white flag on Obamacare. Shortly following the election debacle, House Speaker John Boehner declared that 'Obamacare is the law of the land.'"
DC Republicans always wave the white flag. It's what they do. It's how they go along to get along in their home town. It's up to governors to protect us against the DC onslaught on Obamacare and everything else. My fear is that they'll get bribed with more DC bucks. That always, always the result.
If this is headed to the Supreme Court, they'd better hurry up before Obama nominates replacements and turns the place into a transgender jamboree.
Zeppo| 11.19.12 @ 4:18PM
One small consolation of the electoral wipeout is that we won't have to watch the GOP pretending that they will repeal Obamacare.
Gary B| 11.19.12 @ 9:23PM
You've got that right! They're pretty much worn out their welcome.
Gary B| 11.19.12 @ 8:25AM
There is another lawsuit working its way up the ladder. Because the mandate has been declared a tax, Obamacare is fundamentally flawed, as it originated in the Senate and not the House. Expect this argument to go down in flames, as lawlessness is now the order of the day.
buckeyeman| 11.19.12 @ 9:37AM
This isn't likely to work. Obamacare was cut and pasted onto an already passed House bill. Every pixel of the bill was deleted except for the bill number and was replaced with Obamacare. The Dems believed that this would technically comply with the requirement that a tax bill originate in the house. Any court worth a damn would rule that such "form over substance" monkeyshines fail to comply with the intent of the constitution and flush them. In our case, not much hope.
Gary B| 11.19.12 @ 11:05AM
buckeyman, you're right. Nothing in DC works. When Republicans sell out all day every day, how can anything work?
Rubio has begun his campaign for 2016. If he gains momentum, he will immediately be co-opted by the GOP establishment. They will either bribe him or threaten him. It's how the whole thing works.
Purp| 11.19.12 @ 11:51AM
Upholding the law is not the same as trying to kill a law. Supremes are required to uphold the law, not find ways around it to kill it. Didn't you learn anything from the first time with the Supremes and Obamacare?
George S| 11.19.12 @ 12:33PM
The law states that only states can set up exchanges. Only the states, not the federal government. Clear as day. With all the words spelled correctly. In plain English.
Tell me how upholding the law can only happen by disregarding the language of the law?
Purp| 11.19.12 @ 3:11PM
Wrong, if they don't, the Feds will set one up. Also, very clear.
lost| 11.19.12 @ 12:37PM
The purpose of the Supreme Court is to up hold the Constitution and to decide where any law/action of the other 2 branches violate that. Chief Justice John G. Roberts said that is not what they did. He said that is is not their job to void laws made by congress, to do that is the job of the electorate by voting others in to change it.
Purp| 11.19.12 @ 3:12PM
Okay, and so we have rejected repealing Obamacare, so why can't all the sore losers just shut up now? Does a House have to fall on them?
CJW| 11.19.12 @ 5:30PM
Purp the Village Idiot posted the following after the elections:
"Purp| 11.8.12 @ 10:35AM
"The Lord rules, not Obama." - CORRECT!
The Lord works in mysterious ways... and this is something for the faithful to contemplate in the way the see the world:
Hurricane Sandy and Chris Christie was the Lord's way of pressing his thumb on the scale to tilt in the direction of President Obama. It was His punishment of Republicans for their lying and trying to cheat (Voter Suppression) their way to political victory, while espousing faith, freedom and constitutional credentials."
So purpie believes God killed over 100 persons and destroyed millions of dollars of property to help Obama win.
In Sept Purpie wrote that Amassador Stevens was at fault and caused his death.
Purpie also wrote that the unborn are biological entities not deserving of protection until God allows them to be born. (What does this mean?)
Purpie represents the Loon Left that should be mocked and ridiculed, and not engaged in conversation
gene| 11.19.12 @ 8:34AM
Refuse to go along with Obamacare?
I want to live in a state that is ready to secede altogether.
Trinacria| 11.19.12 @ 9:24AM
In Texas house hunting at this very moment (adios California)...
Russel| 11.19.12 @ 10:00AM
Texas ? . Heck , the rest of Ca. is / has moved here to Wyo .. And Mich . fits right in w/ our weather . We have a solid good conservative governor and are hoping he won't cave . But reading lately it seems all of his sort are thinking they will . Hope it's just another ruse by the socialists . It made me furious all over again - that so many must suffer at the hands of so few . Nelson , Stupak , Landrieu , and the great traitor to our Constitution , Roberts . May he live in turmoil and constantly watch his back .
Gary B| 11.19.12 @ 10:44AM
The life of a conservative citizen: betrayal, after betrayal, after betrayal. It never ends.
I'm convinced the GOP got what it wanted... further movement toward tyranny, without getting blamed for it. It's the false flag operation I've been mentioning. Adding insult to injury, we've financing it!
Gary B| 11.19.12 @ 10:46AM
Have you noticed the Supreme Court seldom settles anything? They torture the language with half decisions and wait years for the case to come up again with the other half. It's one huge make-work project.
C'mon Man!| 11.19.12 @ 3:23PM
Smart, moved to AZ 2 yrs ago, couldn't be happier about leaving the sinking stste of CA
Purp| 11.19.12 @ 11:52AM
Not gonna happen. That's ridiculous because you don't get your way. Are you 12?
George S| 11.19.12 @ 12:34PM
My way is not paying for your healthcare. So in a way I am 12 because, like a 12-year old, I do not want to pay for something you should have to work for yourself.
Purp| 11.19.12 @ 9:40PM
I do, and you should, but if you can't, I don't mind helping pay for your when you need it. You are not a Christian if you mind paying.
In any case, it doesn't matter anymore what you think ... you will pay, unless you are a moocher/lazy good for nothing bum.
Oh, wait, you'll pay then too. So the freeloaders won't get away with it any longer - Isn't that something Ronald Reagan would like?
CJW| 11.19.12 @ 5:31PM
Purp the Village Idiot posted the following after the elections:
"Purp| 11.8.12 @ 10:35AM
"The Lord rules, not Obama." - CORRECT!
The Lord works in mysterious ways... and this is something for the faithful to contemplate in the way the see the world:
Hurricane Sandy and Chris Christie was the Lord's way of pressing his thumb on the scale to tilt in the direction of President Obama. It was His punishment of Republicans for their lying and trying to cheat (Voter Suppression) their way to political victory, while espousing faith, freedom and constitutional credentials."
So purpie believes God killed over 100 persons and destroyed millions of dollars of property to help Obama win.
In Sept Purpie wrote that Amassador Stevens was at fault and caused his death.
Purpie also wrote that the unborn are biological entities not deserving of protection until God allows them to be born. (What does this mean?)
Purpie represents the Loon Left that should be mocked and ridiculed, and not engaged in conversation
Miles Glorious| 11.19.12 @ 9:11AM
gene I am with you!
MERCHMASTER | 11.19.12 @ 10:46AM
JUST DON'T FUND OBAMACARE
>>>> HOUSE OF REPRESENTATIVES
Purp| 11.19.12 @ 11:53AM
Not gonna happen or the R's will lose the House next time around... Don't you people learn anything from defeat?
MERCHMASTER | 11.19.12 @ 10:48AM
WHEN OBAMACARE DOES NOT HAVE MONEY TO FUNCTION IT WILL NOT EXIST
ROBERT WILLIAM GRADY, JR.
Purp| 11.19.12 @ 11:56AM
The people want Obamacare, no rise in military spending and raising taxes on the rich to help balance the budget - Does a house have to fall on you to get that?
Even in the State Legislatures, Republicans lost. Even in Texas!
Keep it up and you'll lose the House next. Only about 16 seats need to switch to lose the House.
Try to learn from your failures, but if you don't, I'm happy to have more blue States.
lost| 11.19.12 @ 12:41PM
And in 4 years when things have not improved you and your kind will still be blaming Bush. Hopefully people will start to wake up by then
CJW| 11.19.12 @ 5:31PM
Purp the Village Idiot posted the following after the elections:
"Purp| 11.8.12 @ 10:35AM
"The Lord rules, not Obama." - CORRECT!
The Lord works in mysterious ways... and this is something for the faithful to contemplate in the way the see the world:
Hurricane Sandy and Chris Christie was the Lord's way of pressing his thumb on the scale to tilt in the direction of President Obama. It was His punishment of Republicans for their lying and trying to cheat (Voter Suppression) their way to political victory, while espousing faith, freedom and constitutional credentials."
So purpie believes God killed over 100 persons and destroyed millions of dollars of property to help Obama win.
In Sept Purpie wrote that Amassador Stevens was at fault and caused his death.
Purpie also wrote that the unborn are biological entities not deserving of protection until God allows them to be born. (What does this mean?)
Purpie represents the Loon Left that should be mocked and ridiculed, and not engaged in conversation
Who Knows?| 11.19.12 @ 12:02PM
The “permanent campaign”?
Where have I heard of THAT?
Why, wasn’t it Bill Clinton who famously spent 8 long years mostly campaigning, and doing some governing? And, NOW, we have the next iteration of Obama, who’s accentuated the campaigning and decreased the governing.
What does that tell you?
Look, the permanent government has passed the tipping point, and there’ll be no going back---short of a cataclysmic political or natural or economical disaster. And, I continue to believe there’s going to be a massive economical correction, that will make the real estate write down look like small beer.
All any future Democratic Party leaders know to do is COPY Obama and Clinton, because their compatriots in the liberal power pyramid will only need cover to continue their permeating takeover of the economy. We are getting to experience fascism, American hate style.
And, the American stupid party, the GOP, has leaders who resemble the farmers who brought on the Dust Bowl. When confronted by worsening problems, they double down on their loser strategy!
Demographics is destiny. So, bring on the illegals, let’s have them vote—for more government as taker!
You can only weep, and marvel in horror at the slow dance of death of America, soon enough to be a fast step off the freedom cliff.
Purp| 11.19.12 @ 12:24PM
Run for the hills, the sky is falling, the sky is falling! Okay, Henny Penny, you've done your part to scare everyone ... unfortunately for you, it's more the "Boy who Cried Wolf" just too many times.
You may not like it, but America will get along just fine now.
CJW| 11.19.12 @ 5:31PM
Purp the Village Idiot posted the following after the elections:
"Purp| 11.8.12 @ 10:35AM
"The Lord rules, not Obama." - CORRECT!
The Lord works in mysterious ways... and this is something for the faithful to contemplate in the way the see the world:
Hurricane Sandy and Chris Christie was the Lord's way of pressing his thumb on the scale to tilt in the direction of President Obama. It was His punishment of Republicans for their lying and trying to cheat (Voter Suppression) their way to political victory, while espousing faith, freedom and constitutional credentials."
So purpie believes God killed over 100 persons and destroyed millions of dollars of property to help Obama win.
In Sept Purpie wrote that Amassador Stevens was at fault and caused his death.
Purpie also wrote that the unborn are biological entities not deserving of protection until God allows them to be born. (What does this mean?)
Purpie represents the Loon Left that should be mocked and ridiculed, and not engaged in conversation
George S| 11.19.12 @ 12:43PM
All it would take is a lawsuit in Wisconsin citing the equal protection clause. Without a state exchange, the petitioner can claim that the benefits of the law are being denied by the inaction of the state to implement the exchange.
A ruling favoring the petitioner will require overturning the Supreme Court's ruling that ObamaCare is a legal choice between buying insurance or paying a fine. How is a person harmed since he has to purchase insurance by law but since he cannot afford he has to pay a fine. Not paying a fine is now conflated with being forced to buy a commodity, in terms that the Congress can regulate it by "taxation"?
This will finally show the stupidity of Robert's reasoning.
Ken (Old Texican)| 11.19.12 @ 2:51PM
Rush is catching hell today about maintaining the Democrats being the Santa clause party.
"Don't insult the voters" (the takers).
Purp| 11.19.12 @ 3:13PM
He plagiarized that from a Senator long ago .. typical taking credit for the phrase. I just don't remember the name of hte Senator.
But, yeah, he should get hell.
CJW| 11.19.12 @ 5:31PM
Purp the Village Idiot posted the following after the elections:
"Purp| 11.8.12 @ 10:35AM
"The Lord rules, not Obama." - CORRECT!
The Lord works in mysterious ways... and this is something for the faithful to contemplate in the way the see the world:
Hurricane Sandy and Chris Christie was the Lord's way of pressing his thumb on the scale to tilt in the direction of President Obama. It was His punishment of Republicans for their lying and trying to cheat (Voter Suppression) their way to political victory, while espousing faith, freedom and constitutional credentials."
So purpie believes God killed over 100 persons and destroyed millions of dollars of property to help Obama win.
In Sept Purpie wrote that Amassador Stevens was at fault and caused his death.
Purpie also wrote that the unborn are biological entities not deserving of protection until God allows them to be born. (What does this mean?)
Purpie represents the Loon Left that should be mocked and ridiculed, and not engaged in conversation
ReaganConservative| 11.20.12 @ 1:17AM
Bull SH*T.. The States, if they wanted, could convene a Constitutional Convention, add a Constitutional Amendment against forced mandating the American people to purchase a product, via the tax authority of Congress, or whatever means the govt tries, etc..
The US Supreme Court / Justice Roberts, let alone Obama and Congress, cannot directly override that US Constitutional Amendment once ratified, and if they did, would be subject to arrest.
But, the States have to have the will to do it.. The question is, will they have te Will.. I will not going to hold my breath for any States to actually do what needs to be done to save this Nation from the destruction of Obama and his Imperial Socialist Marxist Dictator style rule over "We the People".
Obama's radical fascist liberalism, aka socialist marxism, and his useful idiots, have all but destroyed the US Constitution, and America, and either we do something about it, or say good bye forever to Freedom, Liberty, Democracy, and the US Constitution.