Where Have All the Promises Gone?

Commentary from Twila Brase, President CCHF

February 6, 2013


It's time to remember President Obama's promises for his national health care program: Prices would drop. Everyone would be covered. And no one would be left out in the cold.

This past week, the cold truth of reality has arrived and entire classes of people will soon be wondering where all those promises went. The IRS and the U.S. Department of Health and Human Services issued two rules, in which the following broken promises are found:
  • Families of the Employed. Employer-sponsored coverage is considered "affordable" if the cost of the employee's contribution for "self-only coverage" does not exceed 8% of the household income. If, on the other hand, employer-sponsored family coverage does exceed 8%, HHS is proposing a hardship exemption to the insurance mandate. So no penalty, but no insurance or no affordable insurance either.
  • Medicaid-Eligible Individuals. HHS has ruled that individuals who would have been eligible for enrollment in the expansion of Medicaid are exempt from penalties if they live in states that do not expand Medicaid. So no penalty, but no insurance either.
  • People Who Can't Afford Exchange Policies - Individuals who say they can't afford insurance purchased through the exchanges but who experience a change in financial circumstances that would have enabled them to pay are exempt from penalties. So no penalty, but no insurance either.
Legal immigrants get coverage; citizens don't. Due to the U.S. Supreme Court ruling that allowed states to refuse Medicaid expansion, legal immigrants are suddenly going to get insurance when American citizens can't. As explained by CBS Miami, the law assumed that every state would expand Medicaid, so it limited U.S. citizen access to exchange subsidies. Medicaid is their only option. But it gave legal immigrants access to exchange subsidies. Thus, in states  which choose to forgo the expansion of Medicaid, there is subsidized coverage only for legal immigrants. U.S. citizens are left out in the cold.
Still, governors must refuse to expand Medicaid. The promise of 100% funding for two years and 90% ever after is a false promise. It's also a path to government dependency. As I told the Cincinnati Enquirer, in a story carried by USA Today, "The federal government is not in the black. It's very much in the red and we believe they'll eventually say there is no way we can continue fund (sic) at 90 percent. A state looking at its future has to ask, 'What are we really on the hook for long term?'"
So what was Republican Ohio Governor John Kasich thinking? He announced Monday he will expand Medicaid under Obamacare. He has been considered a strong conservative, but ome have already called his decision a betrayal. Indeed. His decision could entitle 578,000 people to taxpayer money. Meanwhile HHS Secretary, Kathleen Sebelius is out trying to assure states that the administration won't back out of its funding commitment for these millions of folks. On Monday she declared, "this isn't a bait and switch." 
That's another promise she can't keep. This administration is on its way out. In four years, Sebelius and President Obama will be history. The next president could very well pull the rug out from under the states and defund the program. It might be the most fiscally wise thing to do for the country.
Let's hope the other 27 states refuse to expand Medicaid. You might take a moment to encourage them.
In freedom,
Twila Brase RN, PHN
President, CCHF

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