Daytona Beach News-Journal
“What comes next after Obamacare decision”
July 1, 2015
By Sal Nuzzo
On Thursday, the Supreme Court, in a 6-3 ruling in the case King v. Burwell, decided to venture from more than 225 years of history to allow something expressly forbidden in Article 1 Section 1 of the U.S. Constitution — the ability of the executive branch to change the actual text of legislation to suit its political wishes. We would predict that administrations, both Republican and Democrat, will cite King v. Burwell for generations to come, whenever the text of a law — whether on government surveillance, banking and financial regulation, even tax law — does not say what the administration wants it to say.
With this ruling, legal challenges to the constitutionality and legislative intent of Obamacare have been, for all intents and purposes, exhausted. Congress passed the legislation, the president signed the legislation, and subsequently the electorate had an opportunity to vote in 2012.
Those of us who believe that the Constitution’s provisions should be taken strictly as they were written by the framers disagree with the court’s decision. But the court has ruled. Individuals who purchase health insurance on the federal Obamacare exchange will be granted taxpayer subsidies that artificially mask the real cost of health insurance. Regardless of whether a state set up its own exchange or relied on the federal exchange, subsidies will flow.
It is widely reported that as the rollout of Obamacare continues, costs will continue to rise and place an even greater strain on individuals, insurers, and a federal government already drowning in debt. Insurance providers across the United States are forecasting double-digit premium increases for 2016, the year the employer mandate kicks in. In Florida, proposed rate increases are as high as 60 percent for certain plans.
So, what now?
There exist specific reforms that Congress and state legislatures should enact that would serve to restore sanity and place our health insurance system on a sustainable track. At the federal level, policy efforts include ending the incentivized structure of employer-provided health insurance by making both employer and non-employer based insurance equitable from a taxing perspective, allowing individuals (and companies providing employer-based insurance) the ability to purchase health insurance from out-of-state providers, and rescinding the individual mandate.
In Florida, reforms should seek to lower the cost of and increase access to health care. These include, but are not limited to:
- Championing innovation in health care delivery. Telemedicine, remote access, and reforming existing state tax laws regarding medical device manufacturing are all helpful first steps to improving access to care — the real root of the challenge.
- Addressing the supply chain. Existing regulations, such as certificates of need, do nothing except restrict the supply of service providers, ensuring higher costs for insurers and patients.
- Expanding scope of practice. Many states face shortages of care providers that will only worsen over the next 15-25 years. Recognizing the challenge now will help head off certain chaos.
- Improving price transparency. Ever wonder what an MRI actually costs? How about that trip to the ER when your child has a bike accident? The problems related to the openness of service costs have been long documented and researched. The distortions in the cost model should be addressed at the root cause.
- Incentivizing charity care. In many states, medical malpractice laws stifle what would otherwise be a robust charity health care system. Do we want to lower the cost of health care? Then reduce the cost drivers, with medical malpractice coverage being one of the biggest.
Americans have been sold a lie for years, and the coming years will begin to reveal the painful truth. The federal government has preyed on our willingness to believe big brother government was the answer. In its King v. Burwell ruling, the Supreme Court has also decided to strike a blow to the U.S. Constitution.
Here’s hoping that our elected officials at the federal and state levels will recognize this for what it is and continue to promote real, long-lasting reforms that will improve our health care system, while protecting personal liberty and our pocketbooks.
Nuzzo, of Tallahassee, is vice president of policy for The James Madison Institute, a Florida-based think tank.