March 29, 2017

November 19, 2012

States Should Absolutely Refuse to Set Up Obamacare Exchanges

From NRO, where there is more:

Proponents of Obamacare are making one argument that some conservatives may find appealing — namely that it is much better, from a states’ rights point of view, to set up state-based exchanges than to let the feds come in and do it themselves. This argument is absolutely wrong. Allowing your states to be deputized as instruments of federal policy is just as bad as bowing to federal commandeering of state agencies, which is unconstitutional.

Let’s begin with the principle that the federal government is not allowed to command states or their officials to do anything. That was settled in the two modern commandeering cases, New York v. United States (1992) and Printz v. United States (1997). The federal government has gotten around that through a variety of schemes under the general category of “cooperative federalism.” The Supreme Court has generally taken a permissive attitude of these schemes, only because the states supposedly retain freedom of choice, “both in theory and in fact.” But it is increasingly clear that their choice is not really free, because they are penalized if they don’t comply with the federal program.

This problem is clear with programs like Medicaid: The feds tax money away from the states (or they borrow it from the capital markets) and then offer to give it back to the states on condition that they comply with federal preferences.

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Let me give you a perfect example of how messed up this already is.  Years ago, in a paroxysm of supposed national guilt over using Bikini for atomic tests, the United States government promised all Micronesians that they would have free lifetime health care paid for by Uncle Sam.  Same for other expenses.  They also gave them the free right to immigrate to the United States.

Half, if not more, of Micronesia now lives in Hawaii.  They have come supposedly because grandma or grandpa has some sort of medical problem which they need first class medical care in Hawaii hospitals, and they need all of their extended family to provide emotional support.  They show up in the hospitals, which must treat them for free under federal law, then the hospitals send the bills to the State of Hawaii which in turn pays the bills and is supposed to get federal government reimbursement.  Except that the federal government stopped full reimbursement in 1996, and so the Hawaii taxpayers are now stuck with the federally mandated medical bills and are out of pocket HUNDREDS OF MILLIONS OF DOLLARS EVERY YEAR for this free health care and other free services Micronesians are legally entitled to under federal law.  The Micronesians now consume 20% of Hawaii social services budget.

Any Hawaii hospital you go to, if you go to the emergency rooms or any of the common area lobbies, you will find them filled with Micronesians just essentially camping out there.

Read this article—I bet you will not believe that this could possibly be true, but yes, it is.  This is what happens if you let the federal government get its nose under the tent:

Needless to say, these are little dark secrets people in Hawaii can’t talk about, because they immediately get labeled “racists” if they start making any noise about any of this.

But there is no way that any State with common sense should sign onto Obamacare—they can just point to Hawaii as one example of what happens.

[1] Posted by Jim the Puritan on 11-19-2012 at 03:38 PM · [top]

About 2 years ago, at a service club meeting, the head the the Vanderbilt health care system, a huge non-profit, talked about the then-new program.  It was a non-political group and presentation.  In response to questions, two points stood out to me.  One is that nobody really knows how it will work since there are more than 1000 places where it says that “The Secretary shall determine….”  Second, he said that it was obvious that those who wrote the bill really did not understand the system they were regulating.  There are many subtle and obvious interactions which they ignored.  Resistance may ultimately be futile, but it may force at least some moderation.

[2] Posted by APB on 11-19-2012 at 04:22 PM · [top]

Doesn’t help that O’care documents were sent to Congress the day/night before the vote.  I mean, sure, it shouldn’t have been a problem, it was only a couple of thousand pages…...

[3] Posted by maineiac on 11-21-2012 at 01:50 PM · [top]

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