Conservatives have been fighting the Patient Protection and Affordable Care Act (ObamaCare) as an unconstitutional government takeover of the health insurance industry since it was rammed through without a single Republican vote in the Senate or the House.
The second anniversary of this law is coming up on March 23. Three days later, the Supreme Court will begin hearing oral arguments on three key questions, before making a final ruling in June:
- Because of their power to regulate interstate commerce, did Congress have the authority to mandate all Americans to either obtain health insurance or pay a penalty?
- Can ObamaCare remain in effect if the mandate is determined to be unconstitutional?
- Can Congress require states to choose between complying with ObamaCare or losing federal Medicaid funding?
George Will summarizes what is at stake at the Supreme Court – the concepts of a limited federal government and federalism:
Spending on Medicaid, a theoretically cooperative federal-state program, is approximately 40 percent of all federal funds given to states and 7 percent of all federal spending… Under Obamacare, however, the cooperative nature of Medicaid has been radically revised in a way no state could have anticipated before becoming inextricably entangled with it.
In theory, state participation in Medicaid is voluntary; practically, no state can leave Medicaid because its residents' federal taxes would continue to help fund the program in all other states. Moreover, opting out of Obamacare's expanded Medicaid would leave millions of poor people without affordable care. So Obamacare leaves states this agonizing choice: Allow expanded Medicaid to devastate your budgets, or abandon the poor.
The Obamacare issues of Medicaid coercion and the individual mandate are twins. They confront the court with the same challenge, that of enunciating judicially enforceable limiting principles. If there is no outer limit on Congress's power to regulate behavior in the name of regulating interstate commerce, then the Framers' design of a limited federal government is nullified. And if there is no outer limit on the capacity of this government to coerce the states, then federalism, which is integral to the Framers' design, becomes evanescent.
Susan Page at USA TODAY reports on the populace's skeptical view of ObamaCare, which was intended to be Barack Obama's signature achievement but has become a significant problem in his reelection campaign. According to a recent USA TODAY/Gallup poll of registered voters in twelve of the nation's most competitive battleground states, there are strong views and considerable opposition to ObamaCare.
In 2008, Obama won all 12 of the "swing states" as defined in this poll. If Obama wins the same states in 2012 as he did in 2008, he would have a 208-179 electoral vote advantage before these dozen states. The Republican nominee would need to win at least 91 out of the 151 electoral votes below in order to win the presidency.
The highlights of the polling:
- 53% of all swing state voters think that it was a bad thing that Congress passed ObamaCare – eight in 10 Republican voters concur
- 76% of swing state voters believe that the law will either make things worse or not make much difference in the long run for their family
- 53% would favor or strongly favor repealing the law if a Republican is elected in November
- 76% of all swing state voters think that the individual mandate is unconstitutional – nine in 10 Republican voters concur
Over the past two years, Obama has been unable to convince us that it was worth the effort. Republicans are united in opposition against him, and his standing among independents has eroded. Page writes that "though the law has avid supporters, especially in the president's Democratic base, the net effect among middle-of-the-road voters is negative for him. What's more, the issue unites the GOP when the party is fractured among competing presidential contenders."
Health care ranks near the top of a list of concerns for advocates and critics of the law. Nationwide, it trails only the economy and the deficit as being the most critical issues facing the nation, rating a bit higher than unemployment and terrorism.
Opposition to the law is eroding Obama's support among the middle-of-the-road voters both nominees will court this fall. Among independents, 35% say the law makes them less likely to support Obama, more than double the 16% who say it makes them more likely.
The intensity of feeling among potential swing voters also favors opponents. Among independents that lean to the GOP, 54% say they are much less likely to support Obama as a result. Among independents who lean to the Democrats, 18% say they are much more likely to support him.
Meanwhile, Mitt Romney has been pandering to conservatives and criticizing ObamaCare, while steadfastly refusing to be honest and admit that RomneyCare provided Obama with a model. In every important respect, ObamaCare is RomneyCare 2.0, as you will see in the following video from the Cato Institute in April 2010:
In the presidential debates with Obama this October, and in the fierce campaigns this fall to win back the Senate and keep a majority in the House, how can Romney lead the conservative fight against a plan that is modeled after his own, while claiming that he didn't provide the prototype framework?
David Boaz, the Executive Vice President at Cato, asked this same question just after ObamaCare became the law of the land. Romney has struggled to explain the difference between his Massachusetts universal-health-care plan and ObamaCare, which both feature "an individual mandate, subsidies, and forbidding insurance companies to deny coverage for preexisting conditions." His argument that RomneyCare was passed in Massachusetts on a bipartisan basis is not a substantive defense, and there is still no legitimate conservative defense of an individual mandate.
Boaz's post concludes with a question: "Can the Republican effort to defeat President Obama and repeal ObamaCare really be led by the first American political leader to impose a health care mandate on citizens?"
I contend that it cannot.
Besides this obvious hypocrisy, RomneyCare isn't doing well enough to justify its existence and is certainly not conservative. James Pethokoukis at the American Enterprise Institute links to an academic study in Health Affairs, a leading peer-reviewed journal of health policy thought and research. Since RomneyCare provided the template for ObamaCare, Massachusetts' experience over the past six years provides a forecast of the impact of ObamaCare. The study notes that:
There is, however, reason to be concerned about employer-sponsored insurance premiums because health care costs in the state continue to rise.
Following her recent article cheering for RomneyCare, Peter Ferrara at The American Spectator educated Ann Coulter, the infamous conservative commentator and Romney advocate, on the individual mandate. Ferrara served in the White House Office of Policy Development under President Reagan, and as Associate Deputy Attorney General of the United States under the first President Bush. He was one of the first conservatives to ring the alarm bell over the individual mandate, when he successfully led the fight to kill the Heritage Foundation health bill that was introduced by Sen. Don Nickles as an alternative to HillaryCare.
Ferrara writes that "the Heritage health plan with its individual mandate was detested throughout the conservative movement", because the mandate inevitably leads to socialized medicine, with larger government to control both health insurance and health care, and an eventual rationing of health care.
If the government mandates what specific health insurance that you have to buy, the politicians are ultimately too weak to prevent everything from being included and covered. Predictably, once everything is included, the mandated insurance is extremely expensive. Ferrara explains the consequences: "As the costs to the government, taxpayers, and others for this mandated health insurance skyrocket, the government will decide it must step in to control costs."
RomneyCare is perceived unfavorably because "it is virtually the same thing as the widely detested Obamacare." Ferrara notes that both include the individual mandate, sharp increases in Medicaid, guaranteed issue and community rating, welfare subsidies for the purchase of health insurance, and the underlying government power for price controls on health insurance and rationing of health care.
According to Ferrara, uncompensated care for "free riders" is just 2% of total health costs – this is always one of Romney's key justifications, but is a weak excuse for the introduction of socialized medicine.
Last year, author Sally C. Pipes of the Pacific Research Institute glimpsed a future with ObamaCare, noting that Massachusetts health care spending is "out of control", and that Romney was lying when he "declared that he could radically expand government health care without it costing more."
Five years in, Bay State residents are being told that global budgets, price controls and rationed care are not only necessary but good for their health. Terry Dougherty, director of MassHealth, said recently, "I like the market, but the more and more I stay in it, the more and more I think that maybe a single payer would be better."
Don't believe it. But do believe this — single payer is the logical and, indeed, likely extension of Romney-Obamacare.
The recent USA TODAY/Gallup polling suggests that Romney shares Obama's health care problem: "Among Republicans and Republican-leaning independents in the battleground states, 27% say they are less likely to support him because he signed a Massachusetts law that required residents to have coverage. Just 7% say it makes them more likely to back him."
During the Republican candidates' debate in Jacksonville on January 26, Rick Santorum effectively argued with Romney on health insurance.
In the Wall Street Journal, author Grace-Marie Turner scores this debate, and notes how Santorum exposed Romney's "weak and contradictory defense" of RomneyCare.
Mr. Romney's attempt to contrast his plan with ObamaCare wasn't convincing. "I don't like the Obama plan," he said in Thursday's debate. "His plan cuts Medicare by $500 billion. We didn't, of course, touch anything like that. He raises taxes by $500 billion. We didn't do that."
These are bogus boasts: States have no authority over cuts in the federal Medicare program, so cutting Medicare never was an option with RomneyCare. Massachusetts didn't raise taxes to finance its plan because it relied on previously enacted health-insurance taxes and an infusion of federal Medicaid money to finance its coverage expansion. The state simply passed a big share of its costs to federal taxpayers.
Mr. Santorum was passionate in insisting that Mr. Romney's defense will collapse in a debate with President Obama, and the candidate would be wide open to attack. "Folks, we can't give this issue away in this election. It is about fundamental freedom," he said.
Mr. Romney has indeed backed himself into a corner by insisting on defending his health plan while attacking ObamaCare. In the Oct. 11 debate at Dartmouth College, Mr. Romney said: "[W]e all agree about repeal and replace. And I'm proud of the fact that I put together a plan that says what I'm going to replace it with."
Does he really mean that he wants to use Massachusetts as a model for his "replacement" plan? No wonder voters are worried.
David Catron writes at The American Spectator that most Republican voters would disagree with Romney that "it's not worth getting angry about."
Romney apparently didn't notice that the hundreds of thousands of people who showed up at the nation's capitol to protest the impending passage of Obamacare were pretty angry. In fact, after the law was passed over their vehement objections, a significant portion of the voters were so outraged by the back-room skullduggery used to pass "reform" that many Democrats were actually afraid to hold town hall meetings and face their own constituents during the run-up to the 2010 midterms. Moreover, despite the many whoppers told by the President's accomplices in the media about the "anti-incumbent mood" of the electorate, the drubbing the Democrats received in that election was obviously driven by voter indignation about being force-fed Obamacare.
Romney's reversals of position have been so frequent and transparently self-serving that a moderately intelligent preschooler could see through them. Health reform is Exhibit A. When running against Ted Kennedy for the Senate in 1994, Romney represented himself as the champion of a free market health system: "I do not believe in a government takeover of the healthcare system." After becoming Governor of Massachusetts, however, his position changed so radically that he signed a health reform law that later became the model for Obamacare. Now, he claims to oppose Obama's version of the plan, though the two laws are identical in all important respects.
Romney would also have us believe that he will repeal Obamacare in its entirety. He has made this claim in virtually every Republican debate. During his exchange with Santorum on Thursday, for example, he phrased it thus: "It's bad medicine, it's bad for the economy, and I will repeal it." Predictably, this differs from what he said immediately after the law was passed: "I hope we're ultimately able to… repeal the bad and keep the good."
When Rick Santorum's tone during last Thursday's debate betrayed annoyance at Romney's health care contortions, it was because he actually cares about the threat to basic liberty presented by Obamacare. It's not an easy thing for a man of genuine principle to tolerate an opportunist like Romney, who obviously sees the issue as just another lever that he can use to hoist himself into public office.
Catron also wonders why Santorum is the only Republican candidate talking seriously about ObamaCare and making the case for why it must be repealed. All of the candidates promise to repeal the law, but besides Santorum they lack passion in their opposition.
Romney, Ron Paul and Newt Gingrich have "failed to give the issue the attention it merits", while Santorum "has not merely explained why Obamacare must be repealed but has repeatedly declared it the most important issue of the campaign… Perhaps the pledges issued by the others amount to nothing more than perfunctory rhetoric meant to mollify the Tea Partiers."
Catron writes that Santorum is well suited for this debate: he is a genuine conservative (unlike Romney), he actually understands that ObamaCare constitutes a very serious threat to individual freedom, and he clearly understands health care in a way that the others do not (even Dr. Paul).
Unfortunately, the media "rarely cover Santorum's comments on the subject unless they can find a way to misrepresent his position as hopelessly doctrinaire and irrational."
Suppose that the Supreme Court rules that the individual mandate is constitutional. While disappointing, we would still have another opportunity with a Republican President and both houses of Congress to repeal ObamaCare in 2013. If Romney sold-out conservatives to introduce RomneyCare in Massachusetts, what would he do if he is the Republican nominee? Should we really believe that a self-serving, inauthentic, unprincipled flip-flopper like Romney will fight as hard as conservatives need him to?
Let's not forget that Romney has previously said that he wants to keep the good parts and just repeal the bad parts of ObamaCare, and back in December 2007, candidate Romney appeared on NBC's Meet the Press to defend RomneyCare, predicting that other states would embrace the individual mandate concept, calling it "a terrific idea" and the "best path":
We cannot throw away two years of fights and hope that Romney governs as a conservative. We must support Rick Santorum, fight the battle in the Supreme Court and Congress, take our conservative message to the voters in the battleground states, and send Romney back to Massachusetts to enjoy his socialized health insurance.
It is worth getting angry about, Mitt.