Patterico's Pontifications

3/14/2013

Boston Globe: Give Obamacare Waiver to Massachusetts!

Filed under: General — Patterico @ 7:48 am

Ted Cruz today tweets:

Indeed, the Boston Globe has suddenly learned that federal regulation of health care might not be the best idea in the world. A March 5 editorial titled Mass. needs an Obamacare waiver for small-business health plans begins with this complaint:

MASSACHUSETTS HAS made a concerted effort in the last few years to rein in health care costs for small businesses. But new federal regulations written to implement the Affordable Care Act threaten to undercut those efforts — and saddle thousands of Bay State businesses with big increases in premiums.

State law currently allows insurers to consider a range of factors that often reduce premiums for small firms. But under the new federal regulations, most of those rating factors will no longer be allowed. For example, insurers won’t be able to consider the risks inherent to the industry a company is in, or whether the company has a wellness program, or how many employees it has, or what percentage of them participate in its health plan. Those regulations will also end discounts for small businesses that have joined health-insurance-purchasing cooperatives. When the law allowing those cooperatives passed in 2010, Governor Patrick hailed it as an important step in addressing health care costs for small firms.

The overall result of those federal regulations is that small businesses with fewer industry risks, a proactive wellness approach, and (relatively) more employees will end up subsidizing companies that would otherwise be more expensive to insure. Because small businesses and individuals are merged into one pool as far as assessing risk, firms will also end up subsidizing the costs of coverage for people buying individual plans.

Yes, they will, Boston Globe editors. And for the people who crafted this legislation consider that a feature, not a bug.

The Boston Globe whines that Massachusetts should not have to suffer these consequences because Massachusetts had RomneyCare. But many of the problems they cite are issues that are going to be a problem for the entire country, not just for Massachusetts. Small businesses all over the country have wellness programs and other steps they take to minimize their risks and expenses, all to keep premiums low. All these businesses are going to get hit, not just the ones in Massachusetts. Bad one-size-fits-all federal regulation is bad everywhere. Instead of seeking a waiver, they should be seeking repeal.

As we come to see how destructive ObamaCare is, we come to see how waivers are yet another way to reward cronies. It’s no accident that the main recipients of the waivers are labor unions, as the Daily Caller reported in 2012:

Documents released in a classic Friday afternoon news dump show that labor unions representing 543,812 workers received waivers from President Barack Obama‘s signature legislation.

By contrast, private employers with a total of 69,813 employees, many of whom work for small businesses, were granted waivers.

Ted Cruz is right. It would be funny to say we all need waivers, every last one of us, but really, we need repeal — because waivers can be taken back, and are another weapon the government can hold over our heads.

Of course, repeal can’t possibly happen unless public opinion changes so drastically that Obama has no choice but to sign a repeal bill. Even then, as a lame duck, he might veto it. But it sure can’t hurt to talk about it.

48 Comments

  1. Ding.

    Comment by Patterico (9c670f) — 3/14/2013 @ 7:57 am

  2. And for the people who crafted this legislation consider that a bug, not a feature.4

    Umm, hunh? Is this what you meant to say?

    Pretty sure that they intended that business subsidize individual policies, which would mean it wasn’t a bug, it was a feature.

    Comment by Kevin M (bf8ad7) — 3/14/2013 @ 8:12 am

  3. under fascism all the rules have special exceptions for people who go above and beyond in support of the food stamp fuhrer of the fatherland

    that’s how it makes all the trains run on time

    nobody likes a late train

    Comment by happyfeet (8ce051) — 3/14/2013 @ 8:23 am

  4. How are exemptions even legal? Either everyone has to follow the rules and laws or no one should.

    Comment by Sean (a4178b) — 3/14/2013 @ 8:36 am

  5. No sympathy.

    They voted for the turd sandwich by close to a two-to-one margin (60% vs. 36%).

    They wanted it. They get to eat it.

    Comment by Another Anon (f43943) — 3/14/2013 @ 8:52 am

  6. Unfortunately Another Anon, they wanted it but it is we whose throat it’s being shoved down.

    Comment by Hoagie (3259ab) — 3/14/2013 @ 9:09 am

  7. As idiotically blue — true blue — the home state of the Kennedys is, I have to admit, in at least one basic way, it’s doing better than another idiotically blue state, that being California. But I’m assuming that statistics there or here aren’t twisted and squeezed in a such a way they become reminiscent of the official unemployment figures for — as one example — Mexico, which show a jobless rate rarely above 3 to 4 percent dating back to something like the early 1980s.

    boston.com, March 7, 2013: The Massachusetts unemployment rate held steady in January at 6.7 percent as the local economy added 16,100 jobs in the first month of 2013, the state’s Executive Office of Labor and Workforce Development reported Thursday morning. The current US unemployment is 7.9 percent.

    Sectors of the Massachusetts economy that added jobs in January included professional, scientific, and business services; leisure and hospitality; and construction, the executive office said. One sector shedding jobs was the category for government workers.

    The Massachusetts unemployment rate was 6.7 percent in December. The state’s average unemployment rate for all of 2012 was initially reported as 6.5 percent. As more data has been analyzed, that 2012 average has been revised to 6.7 percent.

    Earlier this week, the Associated Industries of Massachusetts reported that its monthly business confidence index dropped as Bay State employers fretted about the fallout from the spending debates in Washington.

    Comment by Mark (6ae95d) — 3/14/2013 @ 9:21 am

  8. The Boston Globe whines that Massachusetts should not have to suffer these consequences because Massachusetts had RomneyCare.

    First, the sarcasm: well, Massachusetts, RomneyCare was the blueprint for ObamaCare and you knew it and supported ObamaCare. You [and I include myself in this, as a Bostonian, but not as an Obama voter] went for Obama by double digits. You have failed to elect a single person in a non-special election who opposes ObamaCare. In 2012, you went eleven for eleven in electing ObamaCare supporters to Congress.

    Now, for the real complaints. RomneyCare has been propped up by the federal government for years, mostly for the purposes of keeping it “solvent”. (An extra $275 million a year will do that.) A solvent RomneyCare can be used as a model for the nation.

    Now that Washington got what it wanted, Massachusetts is being dumped. (Politics is a lot like dating.) This latest whining is like a girl crying that he’s still going to take her to the prom, right?

    Comment by bridget (55e4a2) — 3/14/2013 @ 9:28 am

  9. The US Congress will be under great pressure around fall of 2014 to repeal all of Obamacare. Just in time for it to be an issue that sweeps Democrats out of the Senate and House.

    What a huge amount of damage the Democrats have caused upon our economy with this fiasco. I’m having difficulty thinking of any other single act of Congress that was so destructive in wealth.

    Comment by SPQR (768505) — 3/14/2013 @ 9:41 am

  10. The “uninsured” problem should have been addressed by getting rid of the employer stranglehold on group insurance, through tax shelter of insurance purchase for individuals, tax shelters accounts for routing care (HSAs) and put the uninsured in better bargaining position for health care expenditures. Barring Medicaid/medicare from interfering with service provider/ contracts for reimbursement of insurance providers and individuals without insurance would do more than anything to help the uninsured. No government demand to a discount based on artificial cash prices – the market sets the price. Most persons should cover their own routing care expenses, as it used to be. Policies to cover expenses after a high deductible would be used by most. Persons should be able to negotiate the price of any elective procedure, test, or drug, and negotiate directly with physicians and know what their care costs.

    Comment by SarahW (b0e533) — 3/14/2013 @ 9:48 am

  11. But comment above is a lot of wind. We can’t have people in charge of their own lives. They make mistakes.

    Comment by SarahW (b0e533) — 3/14/2013 @ 9:58 am

  12. “insurers won’t be able to consider the risks inherent to the industry a company is in”

    Sounds like they’re talking about workers compensation insurance, not health insurance.

    If Obama has lost Deval Patrick he’s ……………..

    Comment by daleyrocks (bf33e9) — 3/14/2013 @ 10:15 am

  13. If only we could all be wavers.

    Buh-bye ACA.

    Comment by Icy (412f1e) — 3/14/2013 @ 10:40 am

  14. Cruz’ primary and general election campaigns in Texas were generally pretty blogger-friendly. I endorsed him early and got an immediately reaction from the campaign, and were I inclined to coordinate my blogging efforts with others’, there were lots of opportunities. He’s a 21C guy himself, and certainly his staffers are internet savvy. And he’s to the point now where, like Rubio, he’s a target whom the Dems cannot abide, so they will make him pay the full price for every political decision he makes. But he’ll still win the poker game in Texas, and I think he’s going to continue to punch above his weight class (i.e., seniority) in the Senate.

    Comment by Beldar (de838d) — 3/14/2013 @ 10:51 am

  15. Bah. Actually meant to post that comment on the BlogBash 2013 thread. Sorry, I guess, but it still fits here too I suppose.

    Comment by Beldar (de838d) — 3/14/2013 @ 10:53 am

  16. Beldar, the more punching the better.

    Comment by SarahW (b0e533) — 3/14/2013 @ 11:06 am

  17. #10 Huh?

    Comment by Rodney King's Spirit (951136) — 3/14/2013 @ 11:20 am

  18. #17 I think I get it. Make people pay for the most common procedures out of pocket first? That is to say “get rid of assignment?”

    Comment by Rodney King's Spirit (951136) — 3/14/2013 @ 11:22 am

  19. It is time for either the 100-Million-Man March on DC, or the Million-Gun-March (pitchforks and torches optional)!

    Comment by askeptic (b8ab92) — 3/14/2013 @ 11:45 am

  20. Updated to correct the bug/feature dyslexia ;-)

    Comment by JD (b63a52) — 3/14/2013 @ 12:29 pm

  21. After all Romenycare was designed to pilfer hundreds of millions per year from Medicare to pay for coverage of some of its uninsured citizens and provide fiscal relief to its hospitals.

    If now they have to pay for that too, life as a Masshole will bite even more.

    Comment by gary gulrud (dd7d4e) — 3/14/2013 @ 12:42 pm

  22. I’m neither a lawyer nor do I play one on TV, so I might be missing something, but I think these waivers present the next front for a legal challenge to Obamacare.

    I can’t see how what seems to be arbitrary decisions of an Executive Branch official to exempt some states (and, from other provisions of Obamacare, companies/unions/etc.) and not other states/companies can be deemed as anything other than unequal application of the law. I’m waiting for one of those denied a waiver to file suit (in the same way, those not given a religious exemption from having to pay for birth control have already done).

    I don’t hold hope that this would render unconstitutional the entire law, but if the granting of waivers were judged improper, there would be that many more voices calling for Obamacare’s repeal.

    Comment by steve (369bc6) — 3/14/2013 @ 12:44 pm

  23. steve – I thought a while back that New York City said it needed a waiver. Any idea if they followed through and if it was approved?

    Comment by daleyrocks (bf33e9) — 3/14/2013 @ 12:48 pm

  24. It’s sounds from this that RomneyCare is not identical to ObamaCare, or at least there are some ways it allows costs to be kept down that Obamacare does not.

    Comment by Sammy Finkelman (d22d64) — 3/14/2013 @ 12:49 pm

  25. I don’t think Obama will ever sign a repeal – it won’t clearly be a disaster by January 20, 2017, but he might agree to modifications, especially as part of a budget resolution.

    The tax/penalty is not too big for 2014 – the problem starts in 2015.

    There’s another problem: the slogan was Repeal and Replace.

    Comment by Sammy Finkelman (d22d64) — 3/14/2013 @ 12:51 pm

  26. One shouldn’t need to be too smart to know that when people say “X” is great, but they don’t want “X” themselves, there is a problem.

    But that assumes people know that information because someone told them.

    re 10 and 11
    people indeed make mistakes,
    but perhaps the even bigger mistake is to let someone else make your mistakes for you.

    A/the main problem with wanting smart people in the government to take over and make decisions for everyone is that the people in the government are no smarter than anyone else.

    Comment by MD in Philly (3d3f72) — 3/14/2013 @ 12:56 pm

  27. 25. The political prospects for amelioration are slim to none. Amputation, yes, resuscitation, no.

    Comment by gary gulrud (dd7d4e) — 3/14/2013 @ 12:57 pm

  28. steve – Sebelius previously granted waivers of the Medical Loss Ratio requirement of Obamacare to both Nevada and New Hampshire for different periods of time to avoid “market destabilization.”

    Comment by daleyrocks (bf33e9) — 3/14/2013 @ 12:57 pm

  29. One shouldn’t need to be too smart to know that when people say “X” is great, but they don’t want “X” themselves, there is a problem.

    Which is why Paul Ryan couches his replacement for O-Care as extending the Health-Insurance plans that are available to Congress and the Civil-Service to the population at large; where you get to select how inclusive your coverage may be (and cost) or not.

    Comment by askeptic (b8ab92) — 3/14/2013 @ 1:01 pm

  30. Daleyrocks: I don’t know if she granted a waiver to New York. As for Nevada and NH, how would you like to be one of the other states who she deemed wouldn’t destabilize the market?

    I don’t think the Constitution allows Executive Branch employees the right to decide which states have to obey a law and which don’t.

    Comment by steve (369bc6) — 3/14/2013 @ 1:10 pm

  31. Since ObamaDon’tCare is supposed to provide better medical service at cheaper rates for MORE people, how could anyone with half a brain ask to be exempt from it ?

    Who doesn’t want better medical service for less cost ?

    Comment by Elephant Stone (b7e94d) — 3/14/2013 @ 1:11 pm

  32. “As for Nevada and NH, how would you like to be one of the other states who she deemed wouldn’t destabilize the market?”

    steve – I don’t live in a battleground state so it wasn’t an issue.

    Comment by daleyrocks (bf33e9) — 3/14/2013 @ 1:14 pm

  33. I truly believe that there will be massive pressure that Obamacare be effectively repealed within 24 months. The economic condition of the United States will demand it.

    And the timing of the crisis will be in perfect time for the November 2014 election.

    Democrats really are the stupidest creatures on Earth. No wonder they can’t figure out why they look stupid for electing both Obama and Biden to office.

    Comment by SPQR (768505) — 3/14/2013 @ 1:18 pm

  34. SPQR – ironic that they chose 2014 to implement, since they truly believed it would be so awesome that it would provide an electoral boost in the midterm. Yet it wasn’t awesome enough to implement til after Teh One was re-elected.

    Comment by JD (b63a52) — 3/14/2013 @ 1:28 pm

  35. 10. Comment by SarahW (b0e533) — 3/14/2013 @ 9:48 am

    The “uninsured” problem should have been addressed by getting rid of the employer stranglehold on group insurance,

    There’s a secondary reason for employer provided health insurance, besides the tax reasons.

    Employment connected health insurance avoids or mitigates adverse selection. What’s more, you have a population that, almost by definition, must be somewhat healthy, because at least one member of the family is able to work regularly.

    What RomneyCare apparently did was allow insurance companies to dig deep, and pay attention to all kinds of things that could reduce risks, at least when it came to small firms. (big firms, I guess, are stuck and must subsidize small forms in general)

    Under RomneyCare you could pay attention to whether an industry required more physical fitness than average, or employed on the average more younger people (even if they used that factor indirectly) or men (who have fewer health care costs in their 20s and 30s) rather than women (women see doctors more often and have pregnancy associated care)

    ObamaCare, however, insists on community rating and allows a very few things, like age, to be considered, when setting premoums.

    put the uninsured in better bargaining position for health care expenditures.

    I would do one thing. <Medical institutions could not charge uninsured peoiple above the 15th percentile. they shopuld be charged the lowest rates not the highest ones. That would upset the whole apple cart.

    No government demand to a discount based on artificial cash prices – the market sets the price. </I.

    These artificial cash prices just have to be gotten rid of altogether. There's anyway a problem in defining what was billed for.

    Persons should be able to negotiate the price of any elective procedure, test, or drug, and negotiate directly with physicians and know what their care costs

    No. Providers should find it in their own interst to ADVERTISE PRICES. If that’s not happening, any change is a failure.

    Comment by Sammy Finkelman (d22d64) — 3/14/2013 @ 1:29 pm

  36. 34. Comment by JD (b63a52) — 3/14/2013 @ 1:28 pm

    SPQR – ironic that they chose 2014 to implement, since they truly believed it would be so awesome that it would provide an electoral boost in the midterm.

    No, somebody – not Obama probably – somebody in Congress – believed implementation of Obamacare would hurt Democrat chances – that’s why it was pushed past the 2012 election.

    And the bad stuff really only starts happening in 2015 or rather with the filing of your 2105 tax return in April 2016.

    Comment by Sammy Finkelman (d22d64) — 3/14/2013 @ 1:32 pm

  37. We must NEVER stop trying to repeal Obamacare!

    Comment by JoyO (cae178) — 3/14/2013 @ 5:02 pm

  38. ONE … MORE … TIME.

    People get the government they deserve.

    Comment by glenn (647d76) — 3/14/2013 @ 5:17 pm

  39. “Under RomneyCare you could pay attention to whether an industry required more physical fitness than average, or employed on the average more younger people (even if they used that factor indirectly) or men (who have fewer health care costs in their 20s and 30s) rather than women (women see doctors more often and have pregnancy associated care)”

    Sammy – In other words sort of like how commercial health insurance is priced now, based on the employee population and claims history.

    Comment by daleyrocks (bf33e9) — 3/14/2013 @ 5:46 pm

  40. “Persons should be able to negotiate the price of any elective procedure, test, or drug, and negotiate directly with physicians and know what their care costs

    No. Providers should find it in their own interst to ADVERTISE PRICES. If that’s not happening, any change is a failure.”

    I still say the French system, as originally designed, is the best alternative. The health plans are payroll funded and pay a flat rate for services. The patient is then allowed to negotiate a higher price with the doctor who has to advertise his/her prices. The patient pays first, then gets the partial reimbursement a couple of weeks later. All the billing is electronic.

    There are incentives for doctors who accept the amount as full payment. They get health plan paid vacations, etc. Also pensions.

    The system is under stress because of high unemployment and because of an influx of British retirees who refuse to go back to the wonderful NHS for care. The immigrants are allowed to register under a plan that was for the poor. It’s big drain.

    The other thing is that medical school is free so no student loans. Doctors’ incomes are lower but quality is the best in Europe. Most general practitioners do not have college degrees.

    That would have been a good model for reform but we got the worst system in the world in Obamacare. It’s even worse than the NHS.

    Comment by Mike K (dc6ffe) — 3/14/2013 @ 6:17 pm

  41. We just got official word at work today. Our hours are being capped because of Obamacare. This is my eighth year with the company and my reward is to work 25% less than I did last year. We all knew it was coming and it still hit us like a ton of bricks.

    Comment by Lawrence (17c4e6) — 3/14/2013 @ 6:53 pm

  42. Lawrence – sorry to hear that. Perry has been telling us how awesome the unaffordable care act is doing in solving all the world’s problems.

    Comment by JD (b63a52) — 3/14/2013 @ 7:12 pm

  43. It feels surreal. Of course our company is hiring more people, also capped, to cover all of these hours. And the people applying are coming from companies that have, or are putting, a cap in place.

    Well, that’s one way to get the jobs numbers up.

    Comment by Lawrence (17c4e6) — 3/14/2013 @ 7:25 pm

  44. Most general practitioners do not have college degrees.
    Comment by Mike K (dc6ffe) — 3/14/2013 @ 6:17 pm

    Do they do like a year or two of college before med school, or is it like a 6 year program out of high school?

    Comment by MD in Philly (3d3f72) — 3/14/2013 @ 7:29 pm

  45. “That would have been a good model for reform but we got the worst system in the world in Obamacare. It’s even worse than the NHS.”

    But, Mike K., Perry says that they tried real hard so they should get a gold star on their forehead.

    Comment by SPQR (768505) — 3/14/2013 @ 8:06 pm

  46. A retired doc I know had no undergrad degree. At the time the country needed doctors, so they recruited hard.

    Is it just me, or do you have the feeling this horrible law is not going to ever be enacted? It’s just too bad to contemplate.

    Sorry to hear about your situation, Lawrence. I got a 12% premium increase and feel lucky.

    Comment by Patricia (be0117) — 3/14/2013 @ 10:06 pm

  47. The Sugar Free Double Chocolate Chip Muffins was said to have 3.5 g total fat and 0.5 g saturated fat. What it actually had was 9.64 g of total fat and 2.72 g saturated fat. A check analysis revealed that the products had 9.95 g total fat and 1.84 g, still way above what the company was claiming.*

    why’d you lose your job

    ok see there were these like muffins what had like 6.45 grams more fat than they were supposed to

    and?

    and that is NEVER SUPPOSED TO HAPPEN

    oh. But it did.

    Yeah and so game over. Of course game over. What part of 6.45 grams do you not understand?

    I just… I didn’t realize people got fired for that stuff.

    Well now you do. This is America we can’t have 6.45 extra grams of fat in our Sugar Free Double Chocolate Chip Muffins for Christ’s sake.

    But it says sugar free it doesn’t say fat free. How much sugar did they have?

    That is SO not the goddamn point.

    Ok if you say so.

    Comment by happyfeet (8ce051) — 3/14/2013 @ 11:26 pm

  48. 40, 44. Good friends of ours are French physicians, he an anesthesiologist, she an MD/PhD.

    Now US citizens, the French model excluded them from practice.

    Comment by gary gulrud (dd7d4e) — 3/15/2013 @ 7:45 am

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