President Obama and the Democrats thought they could mute opposition to health care reform by adopting the Heritage Foundation Romney plan, and imposing a regressive mandate instead of a progressive or proportional tax. It seems that may not turn out to be the case. Romney now claims it is fine for states to provide/require universal health insurance, but not the federal government.
But what about the Supreme Court case overturning a key part of the Welfare Reform Act of 1996? The Court ruled that states could not limit the benefits of those who move (or are sent) from less generous states to more generous states when they were in need, while benefitting from the lower taxes of the less generous states before and after. How does Massachusetts prevent South Carolina from sending its citizens north to that state when they fall ill? Why do they end up in New York, on our Medicaid plan, instead? New York had better find out, and take action.
Obamacare justified the mandate on the ground that without it only the sick would try to get health insurance. Unless insurance companies were permitted to exclude them on “pre-existing conditions” grounds, the private insurance industry would collapse. But states are in the same situation when it comes to the poor, needy and sick. If they were forced to live with Third World conditions they might think twice about creating them, but as it is other states can’t exclude those with “pre-existing” conditions, be it health or social.
So the “insurance death spiral” could also be a “tax death spiral” for states that end up with lots of sick people, or lots of needy and greedy senior citizens.
I hope that if the Supreme Court wipes out the expansion of Medicaid on the the grounds that required matches are coercive, it wipes out the whole thing, rather than making a political decision. With the amount of their own money New York’s state and local governments were spending on the program, and perhaps a little more, and stop the ripoffs by the health care industry, it could probably provide basic, cost effective care to New Yorkers.
Buy only if New York can get around Saenz v. Roe, which gives states the option of neglecting their own citizens or bankrupting themselves providing care for everyone else’s.
One other thing that should have been brought up is the collective mandate, with businesses required to provide health insurance equally to all employees if any employees are going to have employer-funded coverage exempt from taxable income. To get around this, to have those at the top get the federal subsidy but not other workers, companies often hire workers as temps or permanent freelancers.
If Obamacare is overturned I hope this provision is also overturned. Because our whole health care finance system is garbage, and the Democrats should have had the guts to discard it instead of screwing around. So I’d rather have it collapse utterly than maintain a system in which the better off, the insiders, and older generations get everything and an every rising share of population subsidizes it but is entitled to nothing.