The Corner

Health Care

Medical Journal Pushes to Expand Obamacare

A sign on an insurance store advertises Obamacare in San Ysidro, San Diego, Calif., October 26, 2017. (Mike Blake/Reuters)

For those who thought Obamacare was on its last legs, think again. The medical intelligentsia wants centralized control over the entire health-care system by the federal government, and they are going to keep pushing and shoving until they get it.

In this episode of the ongoing saga, the New England Journal of Medicine — which often takes extreme progressive ideological positions — wants to expand Obamacare, to the point that millions of illegal aliens are legalized so they can receive coverage.

The article, written by bioethicists, first urges the government to coerce states that have refused to expand Medicaid into surrendering through a combination of carrots and sticks. From, Building on the ACA to Achieve Universal Coverage:

The stick is a reduction in the base federal matching rate for Medicaid spending in states that continue to refuse to implement the Medicaid expansion. The carrot is an increase in the matching rate for states that expand Medicaid coverage. These changes need not be particularly large to be effective; for example, increasing expansion states’ base federal matching rate by about 2 percentage points (or reducing nonexpansion states’ base federal matching rate by the same amount) would make expansion effectively free for a typical state. The small size of these adjustments would insulate this approach from being judged unconstitutionally coercive.

There’s no such thing as a free lunch, but never mind.

Next, expand subsidies:

The second step involves increasing and expanding eligibility for the subsidies available through the ACA’s health insurance marketplaces to encourage more people to take up coverage. This step includes increased tax credits to offset insurance premiums, higher cost-sharing subsidies to offset out-of-pocket costs, and extension of subsidies to people with incomes exceeding 400% of the federal poverty level, the current income limit on eligibility for marketplace assistance.

Third, force insurance policies on refuseniks:

They would be automatically enrolled in a “backstop” insurance plan, which could be either public or private. Health care providers would submit claims to the backstop plan whenever people in this group used health care services. On each year’s income tax return, people who lacked coverage other than the backstop plan for at least 1 month during the year would pay a premium for the backstop plan for each month they lacked other coverage, whether or not they actually used the backstop coverage.

Finally, get millions of illegal aliens eligible for coverage by any means necessary:

One sixth of the population [are] undocumented immigrants and therefore ineligible for both Medicaid and marketplace subsidies. The final step to universal coverage would be to ensure this group access to insurance programs. This goal can be achieved by creating a path to citizenship or in other ways. Expanding insurance coverage is far from the only rationale for reforming immigration policy, but without some such reform, genuinely universal coverage is impossible.

Isn’t it amazing how progressive policy proposals tend to dovetail? Gaia only knows what we would do with the millions of additional illegal immigrants that would be induced to sneak into the country by the prospect of health insurance coverage.

Because there can never be enough bureaucrats, the authors also urge expansion of the list of services that insurers must cover without cost and the creation of a public plan. You knew that was coming, didn’t you?

Bottom line: Would-be technocrats are on the march. Medicare for All isn’t the only threat that would consolidate government control over the entire healthcare system. Republicans had better come up with a more liberty-oriented approach — or this hyper-Obamacare monstrosity will become the conservative alternative to a single-payer catastrophe.

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