Trump finally pulls plug on Obamacare
One of former President Barack Obama's most important legacies comes to a close
President Trump is giving people more reasons to stay or move to Massachusetts.
Late Thursday, the Justice Department announced it will no longer defend the provisions of the Affordable Care Act in a suit by 20 GOP-controlled states challenging the constitutionality of the individual mandate. It’s a decision that will likely end the most important legacy of former President Barack Obama and bring to a close, at least temporarily, the elusive goal to provide health insurance to all Americans, whether they want it or not.
There are already a number of people up in arms about the decision, calling it an unprecedented action by the Justice Department to enact the political whims of the president. But it’s not quite as unprecedented as those folks say. All one needs to do is look back at the decision by the Obama administration to drop its defense of the congressionally enacted Defense of Marriage act, a decision that led to legalized gay marriage.
Attorney General Jeff Session, in a letter to Congress, said the administration has determined Obamacare’s mandate is unconstitutional in the wake of the decision by lawmakers to repeal the tax penalty, the key basis for the Supreme Court’s ruling in upholding the law in 2012. By extension, Sessions said, that would also mean the provisions requiring insurance companies to cover customers with pre-existing conditions and not charge added premiums is also a violation of the Constitution.
In those states such as Massachusetts that have their own laws mandating insurance coverage, the decision will have limited initial impact. That, though, is somewhat misleading because only Massachusetts has an individual mandate, even though a number of other states are making efforts to pass such laws.
The individual mandate is the bane of conservatives and libertarians even though it was the result of a proposal from the right-leaning Heritage Foundation back in the 1970s as a path to universal healthcare. The rationale then and now is that in order to cover the sickest, the most well would also need to buy in to balance the spreadsheet as well as avoid people only jumping into the insurance pool when they most need it. But once the late Sen. Ted Kennedy embraced it and Obama used it as the cornerstone of his sweeping law, it no longer was a cause for Republicans.
Some, such as Harvard professor John McDonough, had said Congress’ decision to repeal the tax penalty last December was not a fatal blow to Obamacare and, in some ways, could be a boon to better health policy. But McDonough’s optimistic outlook was based on the retention of the pre-existing conditions clause as well as continued Medicaid funding to support some 13 million people who received coverage they otherwise couldn’t afford.
The Justice Department’s decision to let the pre-existing coverage die with the individual mandate will mean premiums rising in those states that have no law. Some will scramble to pass them before the suit wends its way to its conclusion, which could take months. And the individual and business tax penalty does not expire until 2019, giving a little more breathing room.Sessions letter said the decision would have no impact on Medicaid expansion funding, but that is up to Congress. Massachusetts relies on the Medicaid funding as well as waivers from the federal government to enforce its laws. What are the chances of finding a Trump appointee sympathetic to the Bay State?
Does the decision to enact Trump’s political stances send a message that the practice could become more widespread? That will be a key point in the mid-term elections this fall. The individual mandate is reviled by a majority of voters, according to most polls, but they support the requirement that insurers not penalize someone for pre-existing conditions. Those two diametrically opposed views will have to be reconciled come November or someone will pay the price.