Tag Archives: obamacare

Does Obamacare Contain a Serious Violation of the 14th Amendment?


Is another challenge in its future?

While I’m neither a lawyer nor a legal scholar I do have an interest in things legal.  I also have an interest in the healthcare issue and have posted many original articles and op-eds on this blog.  So when I noticed something at Healthcare.gov that seemed weird and just not right it stuck in my mind.  I bounced my thoughts around with friends and organizations via social media.  Finally when Pacific Legal Foundation tweeted that they were combing through the issue and would address it in a weekly podcast, I felt validated, humbled and eagerly await their opinion.

So what is the issue and could it eventually provoke a fourth (more on that later) Obamacare challenge to reach the Supreme Court?  From the home page of Healthcare.gov, rolling over “Get Answers”, then under “Coverage for…”, finally clicking “American Indians and Alaska Natives” a story of unequal special treatment for one group over others unfolds.

The level of special treatment is shocking in regard to our Constitution’s 14th Amendment which requires equal protection under the law for all citizens.  Qualification comes with membership in a Federally recognized tribe or being an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.

American Indians and Alaska Natives most favorably have no closed season under the ACA.  They can sign up for a health plan on the exchange anytime they want and even change plans once per month.  They can choose to have no insurance at all without paying the tax penalty.  On top of that, up to 300% of federal poverty level (up to around $70,650 for a family of 4) they pay ZERO copay or deductible.  How is this equal treatment under the law?

Every other group not exempted from the law by provisions in the law, generally based on religious beliefs, is subject to the same rules governing the exchanges as anyone else.  This includes a closed season three quarters of the year, a hefty tax for choosing to go uninsured, and reduced copays and deductibles only up to 250% of the federal poverty level on silver plans.

Closed seasons, when there’s guaranteed issue as with the ACA, prevent gaming the system exactly as the special provisions for American Indians and Alaska Natives allow.  No closed season opens the door to only signing up for insurance after the discovery of a serious illness.  This is precisely why employer provided health benefits, which have long been guaranteed issue, have an annual open season for about a month each year, barring specified life event exceptions.  For such plans to work time commitment at all times must be required of everyone.

There is an Indian Health Service already on reservations where Indians can get free healthcare from Indian healthcare providers or others if referred by one, but Healthcare.gov discusses advantages of additionally obtaining plans in the exchanges, suggesting better access to programs not provided by other Indian health programs.  They also suggest this will help the tribe by allowing more services to others, suggesting tribal programs run on a globally limited budget.  Think rationing of services or extended waiting times that accompany such approaches and perhaps the ineptitude of the Veterans Administration as well.

This raises questions of possible reasons if American Indians and Alaska Natives could or should be treated unlike ordinary citizens under the Constitution.  Are they citizens at all?  Aren’t Indians sovereigns within our country, nations within a nation?  The answer seems to be to a point.  The “FAQ” section of the Bureau of Indian Affairs website provides many clues and answers.

First let’s consider eligibility.  Described in the FAQ, membership in a federally recognized tribe is determined by each tribe.  It makes clear that “there is no single federal or tribal criterion or standard” and eligibility for membership “will differ from tribe to tribe”.

If this doesn’t seem loose enough, the FAQ tells us that “blood quantum” is not the only means by which a person is considered, including “how strongly a person identifies himself or herself as an American Indian or Alaska Native”.  As it’s becoming popular to identify outside one’s race or even gender, it appears any of the 561 recognized tribes could open membership to anyone willing to learn the history and customs and believe enough, perhaps even paying a hefty entry fee in the process, thereby granting them special benefits under Obamacare too!

Even among those with sufficient blood quantum, estimated by the Census Bureau to be 4.5 million in 2007, enrolled tribal members are around 2 million, less than one half.  Of the total population more than half do not live on reservations, and can be integrated into the larger society to any degree, while still maintaining tribal membership.

It’s worth noting some of the other facts provided in the FAQ as follows:

American Indians are citizens of the United States and the states in which they reside, and have been so, generally, since 1924.

American Indians have the right to vote.

American Indians can run for and hold any public office as any other US citizen.

American Indians do not have special rights different from other US citizens unless based on treaties or other arrangements.

American Indians do pay taxes like everyone else with the exception of state taxes when living or conducting business on a reservation.

Laws that apply to non Indians also apply to Indians except on reservations where only federal and tribal laws apply to members.  Only state laws do not apply to members when living on a reservation.

American Indians do serve in the armed forces of the United States.

So what is the takeaway of all this?  It seems proper application of the 14th Amendment would back and provide standing for any uninsured non Indian to be exempt from the individual mandate and its tax or require American Indians and Alaskan Natives to be subject to it.

It also seems that any uninsured non Indian tribal member who encounters a serious illness outside the open season without a qualifying event, would have standing to claim harm by being denied immediate access to insurance on an exchange as is afforded American Indians or Alaskan Natives primarily as a result of their ethnicity.  It’s with this I await what the legal minds at Pacific Legal have to say.

Pacific Legal Foundation, which has been defending against government impositions on property rights and liberty since 1973, is involved with another Obamacare case, Sissel vs HHS, that could invalidate the entire law as a violation of the origination clause, and is now under appeal to the Supreme Court.  If accepted it will be the 3rd challenge, hence the chance a possible violation of the 14th Amendment outlined here could eventually become number four.

Pacific Legal produces a weekly podcast each Wednesday and maintains an informative website, both with stories and updates on the many fascinating cases they agree to accept.  Importantly and impressively they represent every client and every case at no charge.  Liberty minded individuals would do well to consider supporting them with a donation.

King v Burwell, Marijuana, and a Path to Marginalize Obamacare in its Presence


States Should Start It / If Weed is Worth it……..

Short of repealing Obamacare the next best thing would be finding a method to marginalize it in its presence.  Oddly King v Burwell, along with 23 states plus DC that approved medical use of marijuana and three plus DC that approved recreational posession and use of the plant, may provide a path to doing just that if King prevails.

King v Burwell is the case challenging whether government subsidies can apply to qualified health insurance sold on exchanges run by the federal government.  Proponents of King, led by Michael Cannon of Cato Institute, and Jonathan Adler of Case Western Reserve University School of Law, contend the law is clear that subsidies can only be applied in exchanges established by the states.  As the issue was raised, the IRS simply declared that federal exchanges too are eligible for subsidies.

Four separate but related court cases challenged this IRS decision, and in November the Supreme Court agreed to hear King.  The case is scheduled to be heard March 4th, with a decision sometime in June.  In the event King prevails, most agree there will ensue chaos of a sudden affordability vacuum if the approximately 5 million people who own qualified health insurance bought in states with federal exchanges lose their subsidies.  This will likely bring intense political pressure to find a fix, even as businesses, relieved of penalties triggered by employees obtaining subsidies will argue for other remedies.

In addition, many individuals will find the cost of unsubsidized ACA triggering plans now exceed 8% of their income, relieving them of the individual mandate and its tax for not buying insurance, except they will then either have to scrape to find the unsubsidized premium or be left uninsured with no other choices.

Several Republican governors of federal exchange states, including rising star Scott Walker are feeling nervous about a King win, and don’t seem to know what they may be able to do.  At a National Governors Association event, they took to saying that it’s Congress’s job to deal with any fallout.  None expressed any ideas of what states may be able to do short of somehow restoring the subsidies.

So what if federal exchange states, rather than looking to Congress, switching to a state exchange or piggybacking on another state’s successful state exchange, as has been suggested, would simply make alternate, non ACA qualified, more affordable choices available off the exchange?

Since I had never seen evidence to the contrary and had been told by both Andrew Schlafly, attorney with the Association of American Physicians and Surgeons, and Oklahoma Attorney General Scott Pruitt, whose name is on one of the other three cases, that they knew of nothing in the ACA to prohibit states from making available non ACA qualified choices off the exchange, I heretofore thought this was possible and within the law.

My take had been that the ACA only defined what must be in health insurance plans to be on the exchange, qualify for subidy, and avoid paying the mandate tax, making possible, with or without King, state provision of a parallel free system along side the government control system, allowing states, with their retained authority to regulate insurance through their insurance departments, the potential to allow or even require the availability of alternate choices off the exchange, understanding non qualified plans would not avoid the mandate tax.

I thought this may be especially attractive to those individuals discovering low cost direct primary care arrangements, where an increasing number of primary care physicians are offering unlimited care for a monthly fee.  Here is a rapidly growing need for pure catastrophic insurance as a compliment, that ACA qualified plans have shut down.

I believed all this.  Then, February 9, in a twitter exchange with Phil Kerpen, President of American Commitment, he sent me a link indicating otherwise.  There is indeed federal code that prohibits what I thought was possible.  The office of my Congressman, also previously unaware, identified it as a law from the 1940s that had been amended by Obamacare.  Talk of leaving no stone of iron fisted control unturned!

So what to do now?  State offer of non ACA compliant health insurance off the exchange, no matter how welcome, or as immunization against the affordability aspects of a King win in 37 federal exchange states, would run afoul of Federal law.  It would be an act of defiance, but isn’t this what 23 states plus the District of Columbia did when they approved the medical use of marijuana?  Taking it further, isn’t this what Colorado, Washington, and now Alaska and DC did by approving the recreational use of marijuana?  So far, for those state actions, the feds have chosen to stand down.  If legal weed is important enough to risk federal admonishment, how is offering citizens, still willing to pay the mandate tax, the choice of affordable non ACA qualified options off the exchange not?  It would seem.

More likely, on an Obamacare challenge, the feds would push back hard, but states would have arguments in defense, as well as significant public support that may even exceed weed, especially if King prevails, subsidies are lost, and a sudden affordability vacuum ensues.  While the stand down on marijuana would mean nothing in a legal sense, it may help state defiance on Obamacare play well in the court of public opinion, giving state officials more backbone to act.

States can point to their continued regulation of health insurance where the feds have found it convenient to not supplant them.  State coverage mandates in excess of ACA essential minimum coverage rules still apply, as do their definitions of regional pricing zone boundaries.  They can question also why their regulation of all other types of insurance remains intact, without federal meddling.

There’s the argument McCarran-Ferguson 1945 still gives states the authority to offer alternatives, so long as they don’t attempt to eliminate the federally designed plans.  They could claim restriction only to such limited choices represents overbearing federal imposition and violates the Constitutionally protected freedom of their citizens to contract.  They could point to a long standing tradition of state regulation of insurance in return for insurance being exempt from federal antitrust law.

Perhaps as important, since the ACA unquestionably allows doing absolutely nothing upon payment of the mandate tax, any opposition would be forced into the absurd argument that doing something substantially more than nothing in protecting others from one’s potential inability to pay their medical bills should be prevented, so long as the tax is paid.  In fact, Congress, seeing this argument play out, may be motivated to specifically allow non ACA qualified offerings and reduce or eliminate the mandate tax for buyers, in recognition of their obvious reduction in potential liability to others by their actions.

If only one state or a few, federal exchange or otherwise, would boldly take this course of action, we would present, at least the opportunity to embark on a path to marginalize Obamacare in its presence.  A parallel free system, alongside the government control system could be created, and repeal would no longer be necessary as people could freely choose which system they prefer.

The sudden chaos of a King win would be the perfect time to have alternate choices available, as the potential to quickly attract sufficient numbers to spread the risk enough to insure viability would be most opportune.  If weed is worth it………

GOP Stuck in ACA Replacement “Plan Trap” as Magic Bullet Solution Hides in Plain Sight


Best Plan is NO Plan

Whether by reaction to charges from Obamacare supporters on the Left, or by their own lack of faith in freedom over planning, Republicans, not one of whom voted for the Affordable Care Act, along with conservative allied groups, think tanks, or prominent individuals, are, by last count, now promoting close to a dozen different concepts of how to replace one version of federal government planning with another less abrasive one.  Despite many replacement proposals, Republicans in congress seem unable to coalesce around any one approach, still leaving the impression they have none.

Some of the proposals are introduced bills. Others are wish lists of items to be in bills.  All have myriad suggestions that either move money around by extending tax deductions or refundable credits, allow formation of small business associations, require price transparency, reform medical malpractice, enhance health savings accounts, shuffle money to states for high risk pools, or various changes to Medicare and Medicaid, among others.

Far away the most popular inclusion is selling health insurance across state lines, itself a dangerous (and here) invitation to Federal micromanagement under the twisted  modern interpretation of the Commerce clause.

Such is the pressure and propensity for government to “do something” that bears on both sides of the political spectrum.  This is the plan trap.

Rarely is there a peep from anyone suggesting that no plan is the proper path, that simple policies to promote, restore, and support the proper functioning of the free market, usually by removing government intrusion rather than supplanting it, should be the goal.  One lone voice, Association of American Physicians and Surgeons past-president Dr Alieta Eck, GOP candidate for the 12th Congressional district from New Jersey, wrote an article defending freedom over planning in January 2014.  She opens:

We constantly are told that “while ObamaCare might not be perfect, the right has not come up with a better plan.” Is it possible that we do not need a “plan” at all?

Think about it. Has the federal government set up a food plan for all? A housing plan? Is the Secretary of Whatever empowered to decide what and when we eat? What kind of house each of us lives in? Of course not. We work, we plan and we buy what we need, saving up for the big-ticket items. Government does not control us, nor should it.

Yet one element contained in a few of the plans and wish lists can be the basis for a market revolution.  Unfortunately, no one seems to have grasped the power of its singular focus.  Had Dr Ben Carson simply stopped at Step 1 of his still in progress 5 step plan he would be almost completely there.

Relatively simple modification, enhancement, and expansion of tax policy surrounding HSAs, done right, has the power to be a true game changer by its potential to encourage employers to drop their long standing provision of health insurance in favor of a defined contribution approach.  It is the magic bullet.  It hides in plain sight, and here is how to get there:

Please follow these simple policy modifications:

1) Decouple HSAs from the requirement to be attached to any insurance policy.  While HSAs could still be attached to insurance (suitable for many), anyone should be allowed (and perhaps even required) to have an HSA.  Monies in HSAs receive rare triple tax advantage and protect others from the owner’s potential inability to pay for needed medical services.

2) Allow the purchase of health insurance or medical services through an HSA.  This establishes favored equal tax treatment without the need for separate legislation.

3) Greatly expand contribution limits to allow #2 to happen.  The HSA can be the tax advantaged conduit for all medically related purchases allowed under it.

4) Allow employers to contribute pre tax to an employee’s private HSA.  This is the crucial trigger for a spontaneous move of employers away from policy provision to defined contribution.  Resulting individual ownership solves portability and suitability issues for those who choose to buy health insurance in the open market through their HSA.  Employers could offer direct contributions or matches to employee HSAs.  Contributions from several employers could be combined, as well as HSA assets among family members’ accounts to purchase one insurance contract if desired.

5) Establish a permanent mechanism whereby Americans can look to each other rather than government for assistance by allowing gifting from one HSA to another both within and beyond family connections.  This is similar to the medical sharing ministry concept without the structure of membership or formal organization.  Any groups could pledge to come to the assistance of each other as needed. Such transfers could keep some people away from Medicaid, where access problems are well known or safely allow lower cost policies with higher deductible amounts.

6) For those in need fund a portion of all government assistance transfer payments into personal HSAs to be used ahead of Medicaid.  The power and influence of ownership is stronger than artificially concocted restrictions on use.  Funds from HSA extend dignity of choice and equal access until exhausted

Nothing more at the federal level may be necessary.  States would have to do their part by discovering their proper constrained regulatory role, requiring sufficient reserves to pay claims and enforcing rather than defining terms of health insurance contracts buyers and sellers find right for them.  All this, of course, requires and follows total Obamacare repeal.

While the benefits of defined contribution in a free market (not to escape or game Obamacare) have been recognized (tops list in American Doctors for Truth Plan) and discussed, no one has suggested a good way to transition. Less attention has been paid to the damage done by employer provision of health insurance, which itself was propelled by government tinkering with wage controls in World War II.

Frank Chodorov, in his 1959 book The Rise and Fall of Society, provides clues to understand why employer provision has been the enabling force of most of our problems.  He argues that a natural law of human behavior leads men to seek the highest degree of satisfactions with the least expense of labor to thereby pursue limitless desires, in order to obtain even greater gratifications.  This leads to efficiencies of effort and specialization of tasks via cooperation with others in forming societies.

Unfortunately this natural inclination also presents a weakness to seek something for nothing.  Such is the case when the employer provision of health insurance disconnects the employee from its cost.  As soon as the employee disassociates health insurance with being a part of his employer’s total cost of his employment, rather than realizing he is really giving his employer permission to spend his money in ways that may be against his best interest, he’s in trouble.  He will request or even demand more, without consideration of alternatives that would be likely choices if he was paying directly.

This then is the source of a gradual movement away from direct payment, even for that normally within the ability to easily afford otherwise, to prepayment schemes that defy the normal purpose and function of insurance to protect assets from expenses that are beyond the ability to pay.

This excess third party payment itself bolsters the illusion of getting “covered” services for free or almost free, even as the premium includes the incentivized overuse of others when not getting one’s own.  It is through these false satisfactions that we accept in healthcare what we don’t see anywhere else in our economy, a situation where almost every transaction involves, at least in part, someone else’s money, driving overuse from both the consumer and provider side along with the associated administrative costs to accomplish it.

It’s not hard to imagine how employer provision of car insurance over time would look just as ridiculous.  Oil changes would require a small copay and many other services would be “covered”.  The brake lobby would have used safety as an excuse to convince legislators to require brake “coverage” in every policy issued, all as employees, under the illusion of something for nothing, would keep asking and demanding more “generous coverage” from employers.

On the other hand, employees reconnected to cost through defined contribution, sparked by simple modification of tax policy related to HSAs, in states that likewise get government out of the way to allow multiple market choices, will make wise decisions that fit their specific financial needs.  The abuses of excess third party payment will naturally end and the free market magic bullet solution some say cannot exist will be a reality.  No one thing can accomplish so much by doing so little.

Note: This article shared to Watchdogwire-Pennsylvania

Open Letter to PA Insurance Commissioner Michael F Consedine

Michael F Consedine
Pennsylvania Insurance Dept

In an October 31 article I questioned whether states could cross the line and offer non qualified health insurance policies along side those conforming to the Affordable Care Act.  I argued a prohibition of this amounts to an assault on freedom to enter into contracts, protected by Article 1, Section 10 of the United States Constitution, and Americans should not be strictly bound to accept only contract terms dictated by a strong central authority in Washington DC.  I noted a long-standing tradition of state regulation of insurance under McCarran-Ferguson 1945.

Only rarely prior to Obamacare had the federal government stuck its nose into insurance regulation, and as far as I know, that only involved health insurance, never any other form.  Insurance regulation was something understood to be handled by the states.

Then Obamacare stood everything on its head.  The federal government would now decide what proper health insurance must look like, that is until this past week when they realized they were in over their heads with an avalanche of policy cancellations and a failed exchange website, upon which they said, in effect, the states are once again good enough to take the reins, if only to bail us out for a while, attempting to shift the focus of public frustration somewhere else.  We broke it.  Now you can fix it.

Prior to realizing the magnitude of the crisis they created, the feds assured us their new policies were somehow better than those “inferior” policies being cancelled, providing more “coverage” that would cost less (after applying money taken from others).  In my mind this is just more lies on top of the big “you can keep your coverage and your doctor” lie.  Yet the biggest insurance lie may be the one we tell ourselves.

As Commissioner of a state insurance department, Mr. Consedine, you should understand the commonly held public misconceptions surrounding the purpose and use of insurance, the notion that somehow low or no deductible, low or no copay, cover everything policies are, in reality,  anything more than costly third party prepayment schemes that benefit no one more than the company that sold it.  Yes, I do mean those dressed up Yugos we call Cadillac plans, as the most extreme example.

You should know that the purpose of insurance is not “coverage” but limitation of risk, to protect assets and provide protection beyond the ability to afford otherwise, and that any attempt to “insure” the ordinary, everyday, or expected is a fool’s game that only insures the incentivized overuse of others will be in your premium.  Yet the warm and fuzzy feeling provided by the illusion of free or almost free when one gets theirs, blinds many people to the fact they are paying for everyone else’s overuse when not getting theirs. It truly is a costly false comfort based in feelings rather than facts.

Indeed, if there is blame for the insurance companies, it is their failure to disclose that what most people say they want is not in the best interest of the vast majority of those saying they want it.  This is the price of a nation poorly educated in personal finance and basic economics.  It is also the challenge of ever hoping to attain real reform.  Insurance companies will continue to maintain their silence as the low end false insurance part of their business is to them as slot machines are to casinos, providing a license to predictably print money thanks to huge numbers narrowing the range of possible outcomes.  Is not insurance, after all, a business based in statistics and probabilities?

Crazy talk?  Then check out Paul Hsieh’s op-ed, “The Only Obamacare Fix Is For Obama To Legalize Real Health Insurance”, published by Forbes this past Sunday.  It is essentially everything I’ve been trying to tell you.  Obamacare thus, rather than fixing anything, only takes a problem and makes it worse!  You should realize these facts, because, after all, you are a Commissioner of insurance.

What you may not realize is the developing movement by physicians to direct pay cash only practice models, such as AtlasMD, a pioneer three physician concierge practice in Wichita, Kansas that offers a family of four unlimited primary care for $120 per month, plus access to wholesale prices on medications and laboratory services.  With the overhead and hassle of third party payers removed, they limit their patient load and offer same or next day appointments that average half an hour and even provide home visits!  This can likely be the future, especially with the availability of low cost catastrophic “real” insurance to compliment it, so long as it can be found.

That’s where you come in, Mr. Consedine.  I know you’ve been complicit with Obamacare from the start, even favoring Pennsylvania’s setting up its own exchange.  Your attitude has been that it’s now the law and we must follow it.  I don’t agree because of the magnitude of the intrusion of Obamacare on our freedom, but respect your view.

Under that same law, though, it is perfectly legal to pay a tax and do absolutely nothing in protecting others from ourselves.  Can it make any sense then, that those same people willing to pay the tax and even forgo the subsidy, should not be able to do something significantly more than nothing in protecting their neighbors from having to pick up for them?  How can anyone argue against that?

As Insurance Commissioner along with our legislators, Pennsylvania should make a stand and tell the federal government that in our state, we will offer qualified policies as required, but also non qualified policies for those who prefer them.  How can doing nothing to protect others be legal but doing something more be illegal?  That makes no sense whatsoever.

Finally, if you don’t think you can make a stand for choice, freedom, truth, limited central government, and local control, then please resign so we can find someone who will.

Thank You

Todd Keefer

Note: This post shared to WatchdogWire-Pennsylvania

Can Obamacare’s “Barrycades” to Insurance Freedom be Crossed?


Gettysburg Battlefield Aug 13 2013

Not so unlike the fences, signs and traffic cones used to unnecessarily block Americans from their open space national treasures during the recent Federal Government shutdown, similar “Barrycades” to healthcare and insurance freedom are limiting Americans’ ability to freely enter into contracts on terms they decide are right for them.  As the millions having their health insurance policies cancelled are learning, there is currently not an option to simply pay the tax, if necessary, and even forgo the subsidy for those willing, in order to keep a health insurance policy they may have owned for years.

While the freedom to contract, as provided in Article 1, Section 10 of the United States Constitution may seem clear to many, who likely consider it one of our foundational rights, it has endured a surprisingly rocky history in our courts, and as such, provides no guarantee of support against the impositions of the Affordable Care Act.  In America today, Obamacare is erecting barriers to contract freedom by attempting to restrict terms of health insurance policies to those dictated by powerful government bureaucrats, in total disregard of individual choice or basic considerations of sound personal finance.

Especially hard to understand is that a tax can be paid to legally remain completely uninsured, yet plans not deemed “qualified” are not supported as better than nothing (and in many cases completely adequate) in relieving others of ever having to pick up for those without the resources to fend for themselves.  Wasn’t that the stated goal all along?  Like so much of Obamacare, this makes no sense and can only be about elitist control, a step into socialism Americans used to think only happened elsewhere.

Also, with a growing healthcare freedom movement by doctors to eliminate third party payers entirely, from at least primary care, by the establishment of direct pay cash-only pay-per-use or concierge practice models, other options will be needed for those who choose this interesting, and so far, legal alternative.  The use of still available critical illness insurance, as a proxy for unavailable pure high deductible insurance that would make much more sense in these situations, has been suggested.  Dr. Merrill Matthews, of the Institute for Policy Innovation, in a recent article in Forbes, shows how being wrapped in a cloak of life insurance has allowed the critical illness insurance option to survive, and may be a good choice, if not ideal, for many.

As I wrote in a post last December, the curious Miscellaneous Provisions, Subtitle G, Section 1555 single paragraph in the Affordable Care Act clearly says that issuers of health insurance are not required to participate under the act, nor can fines or penalties be imposed for choosing to not participate.  When this is combined with the option for states to regulate insurance, as has been tradition under authority of the McCarran-Ferguson Act of 1945, questions arise as to what states may still be able to do.

Even under Obamacare currently, states may add to the essential minimum benefit requirements of insurance needed to “qualify”.  So states are still involved in their health insurance regulation, if only to a much reduced degree.  A question is how far that authority goes the other way.  Could a state right now, in answer to the current mess of cancellations along with a failed exchange website, exploit the crisis to require the suspension and reversal of all policy cancellations within its borders until the exchanges are fixed?  Could they allow and even require companies that want to sell health insurance in their state to offer the choice of non qualifying plans along side or in place of (Section 1555) Obamacare compliant plans, sold off the exchange, now and in the future?  Could states take charge of the situation to the point that, if Obamacare cannot be eliminated, there could remain legal alternative insurance options apart from Obamacare, even if the federal tax would be due and subsidies not available?

Senator Ron Johnson of Wisconsin has made an attempt to settle this question at the Federal level, at least for currently existing plans, with the introduction of what he calls the “If You Like Your Health Plan, You Can Keep it Act“.  Current political reality makes actual passage unlikely, of course, returning to the possibility that states could act on their own.

One of those I respect most in the Obamacare debate, Michael F Cannon, at Cato Institute, told me the Supremacy Clause would make my suggested state actions illegal, however one of the attorneys on a panel event I attended at Cato was less dismissive of my suggestion of what states could possibly do.  Adding further speculation is the answer I got from ehealthinsurance.com when I questioned them about a month ago.  Their first contact representative, told me they expect to see some states “go rogue” and attempt to offer non Obamacare compliant choices in the future.

As with the shutdown “Barrycades”, when free citizens defiantly crossed the lines and prevailed, will there arise states that tell the Federal Government they have gone too far and we the people have had enough?

Note: This post shared to WatchdogWire-Pennsylvania

An Inquiry into Healthcare.gov’s “Special Enrollment Periods”

So here we are, the first day the Obamacare exchanges or marketplaces or whatever are open for business.  I think of it more as the day America stepped across the threshold to possibly inescapable socialism.  That’s just me.

I had a rough day as I realized an error in my last post and had to insert an update and correction to my assertion that guaranteed issue would allow waiting to buy health insurance until the onset of serious illness.  This still could be true but only if it would occur in a subsequent open season, the part I had missed.  Even though I had remembered hearing talk of no limits, the open season requirement went past me because I went with what I thought I had heard without checking it out.  Confession.

I should have questioned this because employer provided insurance is provided guaranteed issue and they generally limit enrollment to open seasons, with exceptions for certain life events.  I knew this.  Of course with employers there is an initial screening based on who they hire so they are never looking at people too unhealthy to work or apply for the job.

In my ensuing gloom I decided to poke around the Healthcare.gov website.  I was just visiting to see what it looked like and learn what I could.  Sure enough I stumbled on this part about not missing the open enrollment period:


Just as with an employer there was the exception for “qualifying life event” and, being curious, I clicked the link and found this:


That example “moving to a new state” jumped off the page.  I sensed fun with that one!  In seconds I hopped on the phone and dialed the toll free number at the bottom of the page.  After a surprisingly short dance through options and with almost no wait I was speaking to a live representative.

My question was brief and to the point.  According to what I had seen, could I choose to remain uninsured, pay out of pocket and then, if I experience a serious illness, simply move to another state to buy a policy outside the open season?  If I could just cross that state line would I be good to go?  These sound like silly questions, and my gut tells me that this exclusion would only apply if I had owned a policy before moving.

The representative though, did not explain or answer my question to satisfy my gut.  His response was, what I can only guess, outside the box of his training.  “Well, I guess so, if that’s what it says,” was his answer!  Duh!

And no, I still cannot believe this representative’s response was correct, because if it was then I should further revise and update “Is Paying the Obamacare Tax a Better Choice for the Young and Healthy“, my last post to this blog.

Screen grabs were off of the Healthcare.gov website.

Note: This post was shared to WatchdogWire-Pennsylvania

Is Paying the Obamacare Tax a Better Choice for the Young and Healthy?

Urgent Update and Correction:

Just as with this article at Business Insider, I missed the fact that enrollment in the exchanges is limited to open enrollment periods.

This does change the risk dynamics of paying the tax rather than buying the insurance.  Any confusion caused by this oversight is regretted.  Even still, those with either few assets to lose or those with sufficient assets to carry them to the next enrollment period, may still want to take the risks as presented in the original post.  The availability of sensible catastrophic true high deductible “real” insurance that Obamacare prohibits and has not been offered in the states would be the answer to this dilemma.

Original Post (with slight unrelated edits):

The following discussion is in no way intended as specific advice as everyone’s situation is different and unique to them, but only as a guide to uninsured young and healthy individuals to understand their choice in whether to buy health insurance on an Obamacare exchange to avoid paying the tax or paying the tax to relieve them of the obligation to purchase the insurance.  The only mandate for the uninsured is to make this choice, not to do one or the other.

The other purpose here is to counter biased government efforts that will insist the only choice is which insurance exchange plan to buy and how to sign up for it, ignoring the possible benefit of paying the tax instead.  This government effort is substantial, as here in Pennsylvania alone, over $6 million of taxpayer money is being directed to one critical thing Obamacare success is dependent on, enrolling as many young and healthy people as possible.  According to Enroll America-Pennsylvania, on July 10, 2013 “health centers in Pennsylvania were awarded a total of $4,196,333 to provide outreach and enrollment assistance.”  They also indicate that an additional $2,071,458 is coming soon to organizations that will act as “Navigators” who will likely never discuss the non-insurance option that is also important for the young and healthy to understand in making their choice.

Young people need to know a few facts of Obamacare at the outset.  Because the law limits charging the old and less healthy more than three times what the young and healthy pay, this shifts more burden to the young.  Offsetting this are premium subsidies to make the insurance choices seem affordable, but as the young advance their careers and their earnings these subsidies fade.  Another important consideration is that shortsighted bureaucrats designed Obamacare to allow no exclusion for previously existing conditions, giving the opportunity to purchase insurance after the onset of a serious illness, even from a hospital bed. Update: Still true, but only if during a subsequent open enrollment period.

The pay-the-tax choice may be useful for young and healthy people who have the discipline to put aside the difference (compared to paying exchange premiums) for their basic normal medical needs, and especially if they then find one of a growing number of physicians offering much lower prices by casting off third party payment for a cash practice.  It must be understood that this choice is not without the risk of an occurrence of a sudden and severe medical condition causing total incapacitation.  This extremely rare event could prevent them from signing up for insurance on an exchange until they are sufficiently recovered to do so.  Update: So long as it is within or until the next open enrollment period.

Putting the sudden-and-severe risk in perspective though is important.  Everyday young healthy people take on huge amounts of student loan debt, with no guarantee of acquiring a job sufficient to easily pay it back, even as student loan debt obligations saddle the borrower for life because  they are not dischargeable in bankruptcy.  Medical debts, on the other hand, can be eliminated through bankruptcy should the highly unlikely occur.  This is where an option to pay the tax and buy a very low cost non-Obamacare compliant policy that pays nothing up to perhaps a $10,000 or even $15,000 deductible, then covers everything above that, would be so useful, but no such thing exists.  Such a plan would be good enough to prevent bankruptcy in most cases and leave substantially less obligation than many young people have willingly taken on with student loans.

It is thus important for young healthy people to see the big picture, understand all their options, then act in their best interest, in reaction to the rules presented to them by the Affordable Care Act.  This discussion has been meant as a guide in starting the navigation of that process.  Additionally, there is a wonderful new resource blog, The Self -Pay Patient, that unfolds a myriad of already available but little known alternatives to insurance, and I highly suggest a visit for anyone serious about learning the many other options available to them, since no government navigator will ever mention any of it.

Note: This post was shared to WatchdogWire