White House To Ignore Court Ruling, Keep Handing Out Obamacare Subsidies


Sarah Hurtubise

The Obama administration will continue handing out Obamacare subsidies to federal exchange customers despite a federal court’s ruling Tuesday that the subsidies are illegal.

A D.C. Court of Appeals panel ruled Tuesday morning that customers in the 36 states that didn’t establish their own exchange and use HealthCare.gov instead cannot be given premium tax credits, according to the text of the Affordable Care Act itself. (RELATED: Federal Court Takes Down Obamacare: Subsidies In Federal Exchange Are Illegal)

But the White House said in response that it will continue handing out the billions of taxpayer dollars in subsidies. White House press secretary Josh Earnest said that while the case continues to be battled out in the courts, the administration will continue to dole out billions in tax credits to federally-run exchange customers.

“It’s important for people all across the country to understand that this ruling does not have any practical impact on their ability to continue to receive tax credits right now,” Earnest said in a press briefing Tuesday.

A three-judge panel issued the ruling Tuesday, concluding 2-1 that the federal subsidies are illegal. The Department of Justice is seeking an en banc ruling from the appeals court, which would require all judges in the court to rule on the case. Eleven judges on the court would hear the case: seven Democrats and four Republicans.

That decision will likely also be appealed to the Supreme Court.

Read more: http://dailycaller.com/2014/07/22/obama-administration-to-ignore-court-ruling-on-obamacare-subsidies/#ixzz38EZleCth

Court rules subsidies illegal for Obamacare…



WASHINGTON — Two federal appeals court panels issued conflicting rulings Tuesday on whether the government could subsidize health insurance premiums for people in three dozen states that use the federal insurance exchange. The decisions are the latest in a series of legal challenges to central components of President Obama’s health care law.

The United States Court of Appeals for the Fourth Circuit, in Richmond, upheld the subsidies, saying that a rule issued by the Internal Revenue Service was “a permissible exercise of the agency’s discretion.”

The ruling came within hours of a 2-to-1 ruling by a panel of the United States Court of Appeals for the District of Columbia Circuit, which said that the government could not subsidize insurance for people in states that use the federal exchange.

That decision could cut potentially off financial assistance for more than 4.5 million people who were found eligible for subsidized insurance in the federal exchange, or marketplace.

The law “does not authorize the Internal Revenue Service to provide tax credits for insurance purchased on federal exchanges,” said the ruling, by a three-judge panel in Washington. The law, it said, “plainly makes subsidies available only on exchanges established by states.”

Under this ruling, many people could see their share of premiums increase sharply, making insurance unaffordable for them.

The courts’ decisions are the not the last word, however, as other courts are weighing the same issue. And the Washington panel’s ruling could be reviewed by the full appeals court here.

The White House rejected the ruling of the court here and anticipated that the Justice Department will ask that the entire appeals court to review it. Mr. Obama’s aides noted that two district courts have thrown out similar lawsuits and therefore argued that judicial opinions have been mixed at worst. Moreover, they said the ruling Tuesday seemed to fly in the face of common sense.

“You don’t need a fancy legal degree to understand that Congress intended for every eligible American to have access to tax credits that would lower their health care costs, regardless of whether it was state officials or federal officials who were running the marketplace,” said Josh Earnest, the White House press secretary. “I think that is a pretty clear intent of the congressional law.”

Reacting to the ruling in Washington, a Justice Department spokeswoman, Emily Pierce, said: “We believe that this decision is incorrect, inconsistent with congressional intent, different from previous rulings and at odds with the goal of the law: to make health care affordable no matter where people live. The government will therefore immediately seek further review of the court’s decision.”

“In the meantime,” Ms. Pierce said, “to be clear, people getting premium tax credits should know that nothing has changed. Tax credits remain available.”

Continue reading the main story

The majority opinion in the case filed here, Halbig v. Burwell, was written by Judge Thomas B. Griffith, with a concurring opinion by Judge A. Raymond Randolph, a senior circuit judge.

Another member of that appeals court panel, Judge Harry T. Edwards, also a senior circuit judge, filed a dissenting opinion in which he described the lawsuit as an “attempt to gut” the health care law. The majority opinion, he said, “defies the will of Congress.”

Judge Edwards said that the Obama administration’s reading of the law, considered in “the broader context of the statute as a whole,” was “permissible and reasonable, and, therefore, entitled to deference.”

A similar approach was sounded later by the Fourth Circuit panel, which said, “We find that the applicable statutory language is ambiguous and subject to multiple interpretations.” The court said it would therefore give deference to the reading of the law by the Internal Revenue Service, which issued the rule allowing payment of subsidies for people in all states, regardless of whether the state had a federal or state exchange.

The decision by the appeals court here is important because the federal exchange serves states with about two-thirds of the nation’s population. In federal and state exchanges, people may qualify for subsidies if they have incomes of up to $45,960 for individuals and up to $94,200 for a family of four.

If it stands, the ruling by the District of Columbia court could undercut enforcement of the requirement for most Americans to have insurance. Without subsidies, many more consumers would go without insurance and could be exempted from the “individual mandate” because insurance would be unaffordable for them.

The ruling also could undermine the requirement for larger employers to offer health coverage to their employees. That requirement is enforced through penalties imposed on employers if any of their employees receive subsidies to buy insurance on an exchange.

The case is one of many legal challenges to the Affordable Care Act in the last few years. The Supreme Court upheld the law in 2012, but said the expansion of Medicaid was an option for states, not a requirement, and about half the states have declined to expand eligibility.

The administration suffered a defeat in a recent struggle over access to contraceptives. The Supreme Court ruled on June 30 that family-owned for-profit corporations like Hobby Lobby Stores were not required to provide coverage of birth control to their employees if the companies objected on religious grounds.

The health care law authorized subsidies specifically for insurance bought “through an exchange established by the state.”

Obama administration officials said that an exchange established by the federal government was, in effect, established by a state because the secretary of health and human services was standing “in the shoes” of states when she established exchanges.

When the health care law was adopted in 2010, Mr. Obama and Congressional Democrats assumed that states would set up their own exchanges. But many Republican governors and state legislators balked, and opposition to the law became a rallying cry for the party.

The lawsuit in Washington was filed by several people, supported by conservative and libertarian organizations, in states that use the federal exchange: Tennessee, Texas, Virginia and West Virginia. They objected to being required to buy insurance, even with subsidies to help defray the cost.

One of the plaintiffs, David Klemencic, who has a retail carpet store in Ellenboro, W.Va., said: “If I have to start paying out for health insurance, it will put me out of business. As Americans, we should be able to make our own decisions in matters like this.”

Similar lawsuits challenging subsidies under the Affordable Care Act are pending in other courts, which could reach different conclusions. In February, a federal district judge in Richmond, Va., upheld subsidies in the federal exchange. While plaintiffs’ interpretation of the law has “a certain common sense appeal,” the judge said, “there is no evidence in the legislative record” that Congress intended to make tax subsidies conditional on a state’s decision to create an exchange.

Stuart F. Delery, an assistant attorney general, told the appeals court here in March that Congress had intended for subsidies to be available nationwide to low- and moderate-income people, regardless of whether they obtained insurance on a federal or state exchange.

Subsidies, in the form of tax credits, are a crucial element of the Affordable Care Act. Without them, insurance would be unaffordable to millions of Americans. The Congressional Budget Office estimates that subsidies this year will average $4,400 for each person who receives a subsidy.

The plaintiffs said that Congress had confined the subsidies to state exchanges for a reason: It wanted to provide an incentive for states to establish and operate exchanges, rather than leaving the task to the federal government.

Obama administration officials said that argument was absurd. The overriding purpose of the Affordable Care Act, they said, was to ensure access to health care for nearly all Americans, wherever they live.

Of the eight million people who selected private health plans from October through mid-April, 5.4 million obtained coverage through the federal exchange, and most of them qualified for subsidies that reduce their premiums.



“… I wouldn’t bet the family farm on this coming out in a way that preserves Obamacare,” he says

By Joel Gehrke

President Obama’s old Harvard Law professor, Laurence Tribe, said that he “wouldn’t bet the family farm” on Obamacare’s surviving the legal challenges to an IRS rule about who is eligible for subsidies that are currently working their way through the federal courts.

“I don’t have a crystal ball,” Tribe told the Fiscal Times. “But I wouldn’t bet the family farm on this coming out in a way that preserves Obamacare.”

The law’s latest legal problem is that, as written, people who enroll in Obamacare through the federal exchange aren’t eligible for subsidies. The text of the law only provides subsidies for people enrolled through “an Exchange established by the State,” according to the text of the Affordable Care Act. Only 16 states decided to establish the exchanges.

The IRS issued a regulation expanding the pool of enrollees who qualify for the subsidies. Opponents of the law, such as the Cato Institute’s Michael Cannon and Jonathan Adler, argue that the IRS does not have the authority to make that change. (Halbig v. Burwell, one of the lawsuits making this argument, is currently pending before the D.C. Circuit Court; the loser will likely appeal the decision to the Supreme Court.)

“There are specific rules about when and how the IRS can deviate from the plain language of a statute,” Cannon explained to National Review Online, arguing that the subsidies regulation fails to comply with those rules.

The IRS can deviate from “absurd” laws, in theory, but the subsidies language is not absurd. “It might be stupid, but that’s not the test for absurdity,” Cannon says. Similarly, the IRS can deviate in the case of scrivener’s errors — typos, basically — but this is not a typo, Cannon says, because the language was written into repeated drafts of the law.

“They not only keep that language in there, but they even inserted it, this same phrase again, right before passage while the bill was in [Senate Majority Leader] Harry Reid’s office,” Cannon says. “So, it’s not a scrivener’s error, either.”

Finally, the IRS could fill in ambiguous gaps in a law. The problem for the IRS, though, is that the subsidies language is not ambiguous. Even Tribe acknowledged that the language is clear, according to the Fiscal Times.

“Yet in drafting the law, Tribe said the administration ‘assumed that state exchanges would be the norm and federal exchanges would be a marginal, fallback position’ — though it didn’t work out that way for a plethora of legal, administrative and political reasons,” the Fiscal Times writes.

Tribe suggested that the case will, like the individual mandate challenge before it, hinge on Chief Justice John Roberts’s decision. “He would be asking himself the hard question: ‘Is it so clear under existing law that it has to be construed in this literal and somewhat bizarre way . . . that subsidies or tax credits cannot be provided on the federal exchanges, or is it sufficiently ambiguous that it gives me the necessary legal wiggle room’ [to side with the administration once again?]” Tribe said.

Forbes contributor Jeffrey Dorman notes that a recent ruling in a case involving the Environmental Protection Agency could make it harder for Roberts to conclude that he has that wiggle room.

“The power of executing the laws necessarily includes both authority and responsibility to resolve some questions left open by Congress that arise during the law’s administration. But it does not include a power to revise clear statutory terms that turn out not to work in practice,” Justice Antonin Scalia wrote in an opinion that Roberts joined in full.

Cannon believes Roberts is unlikely to go through the legal gymnastics used when he upheld the individual mandate as an exercise of Congress’s taxing power, even though it was written into law as an unconstitutional penalty.

“That was a question of congressional power under the Constitution, and this is a question of IRS power under the ACA and Supreme Court precedents,” Cannon says. “The IRS has absolutely zero independent power to tax and borrow and spend. It can only do that which is delegated to it by Congress.”

And he has no patience with Tribe’s suggestion that it would be “bizarre” for Roberts to conclude that only state-based exchanges can receive subsidies.

“He’s obviously trying to coach the Supreme Court on how to rule for the government here,” Cannon counters. “He’s also either ignoring or not aware of the legislative history showing that Congress was considering all sorts of proposals that would withhold subsidies from states that didn’t establish exchanges or do other things.”

“It is clear that he has not researched the legislative history, because there is nothing bizarre about it,” Cannon says.

Top Insurance Company UnitedHealth Doing Better Than Expected Under Obamacare

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Sarah Hurtubise

UnitedHealth Group, one of the country’s largest insurance companies, announced better-than-expected profits as a result of the health-care law Thursday.

Overall, the company took a two percent hit in net earnings in the second quarter due to increased taxes from Obamacare and various growing expenses, but still beat expectations. The insurer’s first-quarter profits decreased by eight percent this year, which it attributed to the health-care law. UnitedHealth’s shares rose more than two percent Thursday morning, according to the AP.

Large insurance companies stand to benefit the most from the health-care law and UnitedHealth’s growing profits come as no surprise. The simple mandate that all Americans must carry health insurance widens the customer base of large insurance companies drastically — as do federal subsidies that prevent customers from feeling the brunt of premium costs.

UnitedHealth expanded coverage significantly through Obamacare exchanges and Medicaid programs. Another 270,000 members gained private insurance in addition to a 19 percent bump, or 730,000 new patients, in Medicaid coverage.

The company earned $1.41 billion overall in the second quarter, down slightly from $1.44 billion from the second quarter in 2013. Revenue rose by seven percent to $32.57 billion.

But a driving factor of UnitedHealth’s earnings came not from its health insurance sales but from its growing IT technology division, Optum/QSSI. Optum’s earnings jumped by 23 percent to $728 million over the past three months, the most growth this quarter of any of UnitedHealth’s divisions. Optum/QSSI recently won a lucrative government contract for the federal Obamacare website HealthCare.gov.

Insurance companies lobbied heavily in favor of the health-care law (and also against some provisions which limit profits) and they stand to profit long-term. But several Republican senators are worried about the level of entanglement between the Obama administration and UnitedHealth’s Optum. (RELATED: GOP Senators Wary Of Insurer, Admin Ties In Obamacare Implementation)

Sens. Chuck Grassley and Orrin Hatch sent a letter to Obamacare chief Marilyn Tavenner requesting an explanation and documents related to potential conflicts of interest between Optum and the Obama administration. They fear the intricate connections between UnitedHealth, a top insurance company, and the agencies implementing Obamacare, which directly regulates UnitedHealth, could give the insurer a leg up over the rest of the field.

UnitedHealth also announced Thursday that it would expand its activity in Obamacare exchanges significantly in 2015 — presenting even further opportunity for any conflicts of interest to become a problem. While UnitedHealth only participated in around a dozen exchanges this year, it will begin offering products in “as many as two dozen” state exchanges next year.

Read more: http://dailycaller.com/2014/07/17/top-insurance-company-unitedhealth-doing-better-than-expected-under-obamacare/#ixzz37lslcjpE

Chicago Faces $67 Million Shortfall After Obamacare’s Medicaid Expansion Busts Budget


Sarah Hurtubise

Chicago’s public health system is facing a massive $67 million shortfall after an early adoption of Obamacare’s Medicaid expansion cost much more than expected, Crain’s Chicago Business reports.

Cook County, which encompasses Chicago and its surrounding suburbs, made a deal with the Obama administration to get an early start on the health care law’s Medicaid expansion in 2012.

But the resulting program, CountyCare, is costing millions more than original projections. The prototype Medicaid expansion lost Cook County $21 million in the first six months of operation — that’s expected to balloon to $63.5 million by November 30, according to the Chicago Tribune.

CountyCare was expected to pad the city’s coffers. In 2013, state officials projected that the new system would bring in at least $28 million by November, Crain’s reported. The cost of caring for the influx of Medicaid patients has busted projections partially because the newly insured are seeking pricier medical care than expected.

While the program has already failed to meet budget projections this year, the problem is likely to get worse in 2015. Medicaid expansion patients are required to use only CountyCare medical facilities for the first year — meaning the county will end up reimbursing itself for much of its spending on CountyCare coverage.

In January, however, CountyCare patients will be allowed to access other health plans and medical providers. That could leave the expanded Medicaid program to cover patients with the most expensive health problems, along with the least ability to pay. If the public health system loses more inexpensive patients next year, the budget crunch will get even worse.

Dr. John Jay Shannon, promoted to the top position at the Cook County Health and Hospitals System just weeks ago, is charged with finding $67 million in savings from the program by November. If he’s unable to, Cook County taxpayers will have to pony up to pay for the program.

Shannon told Crain’s that the county had “unrealistic expectations” that CountyCare would be “some kind of profit center” for the public health system. But Cook County officials were far from alone in thinking the federal funding would boost.

Advocates of the Medicaid expansion nationwide regularly castigate states that have decided against expanding the welfare program. The White House recently released a report attempting to shame states for refusing $88 billion in “free” federal taxpayer funding to expand Medicaid — but Cook County’s experience suggests states may not be able to count on the programs remaining free. (RELATED: White House: Red States Have Saved Federal Taxpayers $88 Billion By Rejecting Medicaid Expansion)

Read more: http://dailycaller.com/2014/07/14/chicago-faces-67-million-shortfall-after-obamacares-medicaid-expansion-busts-budget/#ixzz37eXEcEYQ

Dem SuperPAC warns of trouble in Virginia…


By JAMES HOHMANN | 7/16/14 8:58 AM EDT

A Democratic super PAC focused on reelecting Mark Warner has been making the case to donors that Virginia’s sleepy Senate race could become very competitive — private messaging at odds with public posturing from national Democrats, who argue that the contest should not be on the map and that Warner is safe.

Talking points provided to a potential donor, obtained by POLITICO, are eerily similar to the pitch that Republican candidate Ed Gillespie is making to his own donors.

Virginia Progress PAC, which has since changed its name to the End Gridlock Committee, said in a document distributed last month that it already has $2 million in cash and fundraising commitments and aims to raise another $500,000.

(Also on POLITICO: Beck pleads with migrant parents)

A representative from the D.C-based PAC, which can take unlimited donations, declined to comment on whether the group has met its fundraising goals or when it will go on the air. He said they will file the reports with the FEC when legally required. It was started in late January and raised $675,000 during the first quarter. At the end of March, it had $626,000 cash on hand after spending $49,000.

Robby Mook, who managed Terry McAuliffe’s successful gubernatorial campaign, and Michael Halle, who ran the coordinated Democratic campaign, are spearheading the independent effort to “define Ed Gillespie before he has a chance to define himself.”

Democrats publicly point to polls that show Warner, a popular former governor, ahead by double digits. But the internal message for donors notes that, “at this point in 2006, Senator George Allen was leading anywhere from 10-20% in the polls,” before eventually losing to Democrat Jim Webb.

The gist of the talking points is that the political climate is bad for any Democrat, the health care law is polling poorly and Gillespie is a potentially formidable contender:

(Also on POLITICO: Simas won’t appear before Issa panel)

• “Republicans will try to tie President Obama and Obamacare to Senator Warner. The Senator has voted with President Obama over 97% of the time.”

• “The 2014 midterm elections are shaping up to be similar to the wave elections of 1994 and 2010; particularly with an unpopular President and an unpopular piece of major legislation that will serve as a referendum on the sitting President. … These wave elections are always bad for incumbents, especially ones that have voted for the unpopular piece of legislation.”

• “A difficult political climate coupled with the rising unpopularity of President Obama could affect the Democratic brand as a whole and hurt Senator Warner. … The Affordable Care Act (Obamacare) and the Democratic brand is polling worse than 2010 in many states including Virginia.”

The fundraisers note that Gillespie, a former Republican National Committee chairman, has “the ability to raise considerable amounts of money through his connections from the Bush White House and at Crossroads GPS.”

(Also on POLITICO: Ready for Warren? Backers start site)

“We must safeguard against these attacks and the outside money through an independent group that can define Ed Gillespie before he has a chance to define himself,” the document says.

A big Gillespie challenge is to convince powerful outside groups to invest in his race. Even his friends are not going to throw big money his way if they don’t think he has a clear path to victory. Documents like this one could certainly help in that regard.

Meanwhile, Democratic allies of Warner also note that it is routine for fundraisers to stir up concern about the frontrunner among an otherwise-unengaged donor class to raise money, and that the incumbent has a strong brand and is well-positioned.

Both candidates released their fundraising totals late Tuesday. Warner raised $2.7 million in the second quarter and has $8.9 million on hand, roughly about what he had in the bank at the end of March.

Gillespie, meanwhile, expanded his war chest to $3.1 million, bringing in $1.9 million during the quarter.

On Tuesday, Warner skipped an Obama visit to the Northern Virginia suburb of McLean to talk about funding infrastructure.

“Sen. Warner will be on Capitol Hill today, doing the job Virginians hired him to do,” emailed spokesman Kevin Hall. “He’ll move between simultaneous hearings of the Banking and Finance committees, and several Senate floor votes are scheduled today, too.”

The Warner camp pushed back on the statistic included in the super PAC document — that the senator voters with Obama 97 percent of the time. The figure is also a hallmark of Gillespie’s stump speech, but Warner’s campaign calls it “meaningless” and “arbitrary.”

Read more: http://www.politico.com/story/2014/07/2014-virginia-election-mark-warner-108962.html#ixzz37eNCNH00

Number Of California Doctors Accepting Medicaid Plummets After Obamacare


Sarah Hurtubise

The number of doctors accepting Medicaid patients in California dropped by a quarter from 2013, at the same time that two million new Obamacare expansion patients are joining the rolls.

In spring 2013, close to 109,000 physicians were enrolled to accept patients with Medi-Cal coverage, California’s version of Medicaid, California Health report writes. But after a purge of the lists this spring, just 82,605 doctors are now available, according to the state Department of Health Care Services.

Many doctors have chosen not to continue providing for Medicaid patients in the state after Obamacare forced an update of provider requirements, according to Medi-Cal spokesman Anthony Cava. The updated requirements “have strengthened the department’s ability to deny or terminate providers who do not comply with application requirements,” Cava said.

Others were dropped from the list of participating physicians because they hadn’t accepted a Medicaid patient in the past 12 months, Cava said.

“This has not resulted in a decrease in access to care,” Cava insisted, according to California Health Report.

But Medicaid patients nationwide already struggle to find doctors that accept the coverage, which typically has the lowest physician reimbursements of any federal program. Earlier this year, a Merritt Hawkins survey of physicians in top cities across the country found that just 45 percent of physicians in the 15 biggest cities in the country take Medicaid patients. (RELATED: Less Than Half Of Doctors In Nation’s Largest Cities Are Accepting Medicaid)

In Los Angeles, just 44 percent of cardiologist accepted Medicaid in 2013, along with 36 percent of obstetricians and gynecologists; seven percent of dermatologists; 35 percent of orthopedic surgeons; and 53 percent of family practice physicians. According to the state’s data, those numbers will now fall even further.

The drastic drop couldn’t come at a worse time for low-income customers in California, which has signed up more new Medicaid customers than any other state as part of the health-care law’s Medicaid expansion. California has two million more Medicaid sign-ups from the expansion, bringing its grand total to 10.5 million Medi-Cal customers statewide.

State officials are already struggling with the large influx. California was one of six states to be called out by the federal Obamacare and Medicaid administrator, Centers for Medicare and Medicaid Services (CMS), for failing to address its staggering backlog of Medicaid applications. The state owed CMS a plan on how to address its 600,000 application backlog last Monday.

Read more: http://dailycaller.com/2014/07/15/number-of-california-doctors-accepting-medicaid-plummets-after-obamacare/#ixzz37a5tgY6k

Get ready for even higher health insurance premiums



As early as 2007, President Obama promised that under his proposed health care reform law, insurance premiums would go down by $2,500 per year for the average family. To put it mildly, that hasn’t happened under Obamacare — and the rising rates are likely to increase again soon. According to a county-by-county analysis published last month by the Manhattan Institute, individual market insurance premiums have increased by 49 percent on average in 2014 after the most recent round of Obamacare regulations went into effect.

The increases were much worse in some places than others. The average 27-year-old man in Miami, for example, is now paying 59 percent more this year than in 2013; in Philadelphia, he’s paying 68 percent more; in both Las Vegas and Little Rock, the rates for 27-year-old women more than doubled, and the rates for men of that age more than tripled. In North Carolina, rates for 64-year-old men and women nearly tripled as Obamacare took effect, requiring a more expensive and often unnecessary set of benefits.

The average rate increase across the 16 states is 7 percent, but it varies by insurer and location within a state.

That’s a far cry from Obama’s promise, and if the early data are any indication, it’s about to get a bit worse for the residents of most states. As the Washington Examiner’s Philip Klein noted recently, insurers are currently proposing new rates for 2015. PriceWaterhouseCoopers has released a study of the 16 states that have made insurers’ filings public. Although a few of the insurers have announced they plan to bring rates down — one of them by as much as 23 percent in Arizona — the general trend is upward. The average rate increase across the 16 states is 7 percent, but it varies by insurer and location within a state. In Colorado, the rare state where Obamacare actually did bring down premium rates in its first year, insurers are now planning to claw back lost profits, with the result that some customers will face increases as high as 35 percent.

The highest proposed increase in Indiana is also 35 percent. As Klein notes, Hoosiers will soon pay, on average, about three times as much ($514 per month) for individual market insurance plans as they paid in 2013 ($174 per month). Although some low-income families will receive help from the federal government to pay these inflated prices, such subsidies only put taxpayers on the hook. Even worse, rates are only as low as they are now because insurers have narrowed their provider networks to the vanishing point — in some states forcing patients to drive long distances for care.

This brings to mind one of Obamacare’s most important lessons about government overreach. A simple expansion of Medicaid or a law assisting people who were uninsurable due to pre-existing conditions could likely have insured as many new people as Obamacare without being so unpopular. But Obama grandiosely insisted on the kind of “fundamental transformation” of American health insurance. That’s why Obamacare has disrupted the already-insured and made health insurance significantly less affordable for millions of middle-class families.