The fight against Obamacare has become a war of attrition and, as George Will notes in his column today, those who would implement that awful policy are caught between a rock and a hard place because of the manner in which Supreme Court upheld the law.
Obamacare requires that insurance companies accept all new customers, regardless of pre-existing conditions, and that the insurance companies base their premiums on age, geography and whether or not they smoke. Lifestyle choices and other issues cannot be factored in.
These mandates will – in fact, already are – raise the cost of health insurance. They also would allow healthy Americans to opt out of paying for insurance until they’re sick. Why pay for something you don’t need? Why not put off paying for it until you need it, especially when the law guarantees that you’ll be able to buy it?
That’s where the insurance mandate comes into play. Obamacare penalizes those who don’t buy insurance with a tax hike, which is intended to force healthy Americans into the insurance pool so that said pool isn’t merely populated with people who are already sick. Without healthy people paying into the insurance pool to provide the funds that pay for the care for the sick the whole concept of “insurance” collapses.
This was a key question before the SCOTUS. Was the Obamacare mandate a penalty or a tax? The SCOTUS ruled that it was merely a tax, but only because it was so low. “[Chief Justice John] Roberts noted that a person earning $35,000 a year would pay a $60 monthly tax and someone earning $100,000 would pay $200,” writes Will. “But the cost of a qualifying insurance policy is projected to be $400 a month.”
There’s the rub. Even with the Obamacare mandate penalty/tax, it’s still a better deal for healthy Americans to pay the tax and delay signing up for insurance until they’re sick. But the dilemma Congress has is that if they raise that tax to truly punitive levels that would actually be effective in pushing Americans into the insurance pool, the run this risk another review by the courts that might not come out as well as the last one.
What does any of this have to do with Jack Dalrymple and North Dakota?
Consider that Dalrymple included in his executive budget an expansion of the Medicaid program mandated by the Obamacare law. “We try to leave the politics out in the hallway when we make these decisions,” Dalrymple told the Grand Forks Herald about his decision to include the expansion in his state budget. “In the end, it comes down to are you going to allow your people to have additional Medicaid money that comes at no cost to us, or aren’t you?” he said. “We’re thinking, yes, we should.”
Setting aside Dalrymple’s objectionable reference to federal tax dollars as coming at “no cost to us” (we’re all federal taxpayers too, Governor Dalrymple) it’s worth noting that the Medicaid expansion is a key element of Obamacare. By making more people eligible for Medicaid, Obamacare takes pressure off the aforementioned insurance pool. Through this dramatic expansion of Medicaid, the cost of which the feds are picking up now but which will inevitably fall to the states, Obamacare mitigates the the pressure put on the national insurance pool.
This isn’t about helping low-income North Dakotans (the state’s economy is booming anyway, the budget for these sort of programs ought to be going down) but rather propping up a wholly objectionable national health care law which most North Dakotans oppose.
Dalrymple has no business supporting it.