Critical Condition

NRO’s health-care blog.

Post-Court Report: Sally Pipes on the Future of Health-Care Reform in America


Sally C. Pipes is president of the Pacific Research Institute and author of The Pipes Plan: The Top Ten Ways to Dismantle Obamacare. She reviews this week’s Supreme Court oral arguments and the state of health care in America, politics and all.  

KATHRYN JEAN LOPEZ: What’s your greatest hope and greatest fear about the Supreme Court and this individual-mandate case?

SALLY C. PIPES: On the Supreme Court hearings and the individual mandate, my greatest hope is that a majority of the justices decide that the mandate is unconstitutional. My greatest fear is that they decide it is constitutional and then the power of the federal government to force us to purchase things in the private market will have no bounds — health insurance first and then Prius cars, burial insurance, a ban on red meat.

: Could we live with an individual mandate? 

PIPES: I believe it would be very bad for us if the individual mandate remains part of Obamacare. The cost of insurance will increase and it will not reduce the number of uninsured. In our amicus brief to the court, we were able to show that the cost shift from the uninsured to the insured for uncompensated care will increase by $3–$5 billion because of the individual mandate. This is diametrically opposite to the administration’s claim.

: Could Republicans ironically lose a clarifying issue in the election this fall if the Court strikes down the mandate? 

PIPES: Should the Court strike down the individual mandate, I think it will be a positive development for Republicans seeking office. Two years after signing the law, 56 percent of Americans support repeal of the Affordable Care Act. On the individual mandate, 72 percent favor repeal. In the 2010 congressional elections, one of the main reasons Republicans took back the House and made gains in the Senate was because of their disdain over government’s takeover of the health-care system. #more#

: Does anyone really know what the implications for the entire law would be if they did strike it down? 

PIPES: If the entire law is struck down by the Court, I think it will be very positive for Congress to prepare a health-care bill that will lead to affordable, accessible, quality care for all Americans. Obamacare will not lead to universal coverage and will not bend the cost curve down. The CBO recently estimated that the cost of Obamacare will almost be $1.76 trillion from 2012 to 2022. It is a far cry from the president’s desire for a plan that cost $900 billion over ten years. The real cost will probably exceed $2.6 trillion over the decade 2014 to 2024.

: Is Romneycare ultimately a help or a hindrance to Mitt Romney as a general-election candidate? As a prospective conservative problem-solving president?

PIPES: I think that the president will try to use Romneycare as a tool against Mitt Romney should he be the Republican candidate. Romney will have to emphasize over and over again that if elected president his first order of business would be to get Congress to repeal Obamacare and that he would sign the bill. Such a move would help him with conservative voters who are skeptical of Romneycare and who see the similarities between Romneycare and Obamacare.

LOPEZ: Has anything surprised you this week? 

PIPES: Prior to the three days of Supreme Court hearings, I was very nervous about how the justices would deal with the Anti-Injunction Act and whether the mandate is a tax or a penalty. On the constitutionality of the individual mandate, I was worried about the positions of Justices Kennedy and Scalia. Following the hearings, I felt encouraged. However, it is not possible to predict the votes and we will have to wait for their decisions on the mandate, and if it is struck down, whether the law can survive and whether the federal government has the power to coerce the states to expand their Medicaid programs for low-income Americans.

LOPEZ: How is Obamacare already harming innovation? 

PIPES: Obamacare is harmful to innovation in the pharmaceutical and medical-device industries. Investment in research and development is already down because of Obamacare. Excise taxes on drug-company sales are already in effect. In 2013, there will be a new 2.3 percent excise tax on medical-device companies. We have already seen firms such as Stryker announce they are going to cut their workforce. These industries are job creators and will no longer be unless the Affordable Care Act is repealed and replaced.

LOPEZ: What do you make of the Department of Health and Human Services contraception/abortion/sterilization mandate debate? 

PIPES: On the HHS mandate that would force insurance companies to provide free pills for contraception, etc., I feel it is wrong and an invasion of people’s personal liberty. On a broader level, it is part of the president and the administration’s goal to increase the mandates on insurance companies, which increase costs of coverage.

LOPEZ: You write that “if the Supremes let the law stand, then the federal government’s power will effectively know no bounds.” Isn’t that just a right-wing talking point? A wee bit of an exaggeration?

PIPES: If the Supremes let the law stand, it is absolutely true that the federal government’s power will know no bounds. This was definitely evident in the hearing on Tuesday which focused on the constitutionality of the individual mandate. As Justice Kennedy, the likely swing vote on the Court, said “the ACA would change the relationship between the individual and the federal government.” He also asked Solicitor General Donald Verrilli “what constitutional power the government has to force all Americans to buy health insurance?”

: Where do you stand on calling it Obamacare?

PIPES: I have written two books with Obamacare in the title: The Truth About Obamacare (Regnery 2010) and The Pipes Plan: The Top Ten Ways to Dismantle Obamacare (Regnery 2012). It was the president’s goal to be the first president in 75 years to achieve health-care reform. Hence, he owns it and the American people don’t endorse it.

LOPEZ: What happens if the individual mandate stands in court and Barack Obama is reelected? If it goes down and Barack Obama is reelected?

PIPES: If President Barack Obama is reelected and the mandate stands, it will be very difficult to repeal and replace Obamacare because he will veto any repeal bill. I think because the main cost drivers come into effect in 2014 — Medicaid expansion, employer and individual mandates, federal subsidies, ending of caps on insurance companies, and no price differential on policies for those with preexisting conditions —  it will be difficult in 2016 under a new president to reverse the law.

If the mandate is struck down and the president is reelected, I think Obama and the administration will try to move forward with the parts mentioned above, with the exception of the guaranteed-issue and community-rating provisions.

LOPEZ: “Our congressional leaders can repeal Obamacare and replace it with market based reforms that actually expand access to coverage, provide quality care, and reduce the cost of health care.” Is repeal really for real? And why are you so confident that something — never mind something market-based” would really come after it?

PIPES: The American people fear that if the legislation is not repealed, private insurers will be crowded out and we will all be left in a Canadian-style “Medicare for All” system with long waits for treatment and rationed care.

Strong leaders in Congress and a GOP president with backbone can repeal of Obamacare and introduce a new bill with market-based reforms that empower doctors and patients.

LOPEZ: Do you like anything you’re hearing from any elected official or anyone who wants to be one? 

PIPES: I think several elected officials are on board with repeal and replace, and more are joining the movement. They include Dr. Tom Price (R., Ga.), Senator Tom Coburn (R., Okla.), and Paul Ryan (R., Wisc.) to name a few.

LOPEZ: What’s so special about “The Pipes Plan”? 

PIPES: The Pipes Plan was written in an easy-to-read format so that politicians and candidates can articulate a ten-point plan to really bring about health-care reform that empowers doctors and patients. Understanding health-care reform is similar to unraveling an onion — many layers and many tearful moments. I wanted to make a reform agenda that works for all.



Subscribe to National Review