Obamacare: If You Don't Like Your Promises, You Can Break Them

The case against noble lies.

“We have to pass the bill to find out what’s in it.” Nancy Pelosi uttered these remarks at the height of the Obamacare debate, and they have haunted her ever since. Unfortunately, “what’s in it” has also haunted the rest of us.

That’s why the Obama administration keeps changing what’s in it. At least ten major provisions of the law have been delayed or waived since its enactment, some of them more than once, most of them without congressional approval. The law’s 1099 reporting requirement was repealed by Congress, the other changes mainly constitutionally dubious audibles the president has called himself.

But these controversial delays and tweaks aren’t the only Obamacare alterations worth attention. The Affordable Care Act was sold as legislation that would extend health insurance—and substantially private insurance—to the uninsured while lowering costs for most everyone else.

To be sure, the administration claims to have kept these promises. “Because of the Affordable Care Act…more than nine million Americans have signed up for private health insurance or Medicaid coverage,” President Obama said during the State of the Union address, with 6 million getting Medicaid.

“The bottom line is this: 10 million Americans have health insurance today who would not have had it without the Affordable Care Act. 10 million,” Illinois Democratic Sen. Dick Durbin claimed on CBS just last weekend.

Obama’s numbers are based on the Centers for Medicare and Medicaid Services (CMS) report that 6.3 million Americans were determined to be eligible for Medicaid between October and December. But that figure includes many people whose eligibility wasn’t affected by Obamacare’s Medicare expansion.

Durbin’s numbers suffer from the same flaw. The health care advisory firm Avalere estimates that only between 1.1 million and 1.8 million people actually enrolled in Medicaid through December thanks to Obamacare. And the widely touted 3 million figure for people who have gained private insurance through the new healthcare law is also flawed.

Not only is the 3 million likely to count people who have selected plans through the notoriously glitchy HealthCare.gov website without having paid for them. It also counts people who already had insurance before Obamacare became law.

A McKinsey & Co. survey found that only 11 percent of Obamacare exchange customers were previously uninsured. Individual insurers have estimated that between 65 and 75 percent of their new customers had insurance before Obamacare.

At the beginning of the year, the number of insurance plans canceled due to Obamacare’s regulations exceeded the new enrollments in the Obamacare exchanges. For many consumers premiums are now higher, not lower, and the benefits are not the same. The president’s pledge that people could keep their plans and their doctors if satisfied has long since been exposed as a myth.

The Obama administration remains committed to its theory that its reinvention of the health insurance market is better than the pre-Obamacare status quo, which was definitely in dire need of improvement. But these broken promises matter because it is highly unlikely the American people would have voted for the policies that have since been foisted on them.

Would Obamacare have become law if lawmakers openly said that much (perhaps most) of the new coverage be churn from old, canceled plans to new Affordable Care Act-compliant ones? Would centrist Democrats have bet their seats on a health-care law that wouldn’t let people keep their doctors and insurance plans?

How many Blue Dogs would have voted for a health care law that, instead of increasing employment as advertised, will actually lure the equivalent of 2.5 million full-time employees out of the labor market? Would rural lawmakers have signed up for a Medicare expansion that could exacerbate physician shortages for many of their constituents?

To ask any of these questions is to answer them. We have become accustomed to a certain amount of chicanery in politics. Some think there is even room for noble lies since the government knows best.

But the American republic was always based on such quaint notions as the consent of the governed. The Constitution should be followed not out of some obligation to heed the wisdom of long-dead white males in powdered wigs, but because it represents the powers the ratifying public willingly transferred to their government.

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