Year Two of the Obamacare Era
Things have only gotten worse.


Avik Roy

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. The law’s advocates confidently predicted that it would cut bankruptcies by half, save tens of thousands of lives every year, create 400,000 jobs “almost immediately,” and even ensure that no one would ever again have to die of cancer.

In Year One of the Obamacare era, we got a preview of what is to come. We know that Year Three will be pivotal for the law’s future, between the Supreme Court and the November election. But it was what we learned in the last twelve months that set the stage for this pivotal, upcoming year.

MAY 2011

Massachusetts continued to give us a preview of what Obamacare would do to the country. In May, studies found that, contrary to what was promised, the new health-care regime increased emergency-room crowding, and increased already-long wait times for doctors’ appointments.

We also learned that the Massachusetts Uncompensated Care Pool, which was meant to cover hospital care for the uninsured, was being quietly used to subsidize the state’s expanded Medicaid program.

JUNE 2011
June was a big month for the law, as many of the constitutional challenges to Obamacare — most notably Florida v. HHS — made their way into federal appeals courts. In that case, Eleventh Circuit chief judge Joel Dubina asked the most fundamental question of all: “If we uphold the individual mandate in this case, are there any limits on Congressional power?” Unfortunately, in my view, advocates for the states whiffed in making the case that the law, in its entirety, should be uninformed.

In a separate case in the Sixth Circuit, Thomas More Law Center v. Obama, the court ruled that the individual mandate was indeed constitutional. Notably, Judge Jeffrey Sutton, a George W. Bush appointee and a Federalist Society favorite, opined that the “government has the better of the arguments” because “few people escape the need to obtain health care at some point in their lives.”

In oral argument in that case, Neal Katyal, the acting solicitor general for the Obama administration, argued that the individual mandate wasn’t a big deal because it “only kicks in after people have earned a minimum amount of income. . . . Someone doesn’t need to earn that much income.”

Outside the courtroom, the McKinsey Quarterly published an important survey that found that 30 percent of employers intended to “definitely or probably” stop offering health insurance to their workers after 2014, when Obamacare’s taxes and subsidies kick in. Among employers who were most familiar with the law’s features, 50 percent intended to drop coverage. Democrats flipped out, futilely attempting to portray McKinsey as a right-wing conspirator. (McKinsey’s employees gave far more to Obama than McCain in 2008.)

Having succeeded at exempting labor unions and other Democrat-friendly organizations from Obamacare’s regulations — the “waivers for favors” program — the Obama administration said that it would not grant waivers to additional organizations.

A survey published in the New England Journal of Medicine found that two-thirds of children on Medicaid were denied a doctor’s appointment for an acute condition, such as uncontrolled asthma or a broken forearm, compared to only 11 percent with private insurance. Obamacare adds another 17 million people onto Medicaid. A glitch in the law, it was discovered, placed 3 million additional Americans onto the program.

In response to the NEJM study, the government announced it was going to sponsor its own study, in which “government snoops” would pose as patients, in an attempt to figure out which doctors weren’t accepting Medicaid and Medicare patients. After a public outcry — or as HHS put it, “feedback received during the public comment period” — the government abandoned the idea.