One year ago, when President Obama signed the Patient Protection and Affordable Care Act, he proclaimed it would lower costs, reduce the deficit, and lift the drag on our economy. Since then, insurance premiums have not dropped; coverage has not increased; over half of the states have filed suit against the Department of Health and Human Services; and two courts have declared the legislation unconstitutional. Shouldn’t a year be long enough for Obamacare to secure a place in our hearts and minds?
Not when the bill is an unpopular, unconstitutional legislative behemoth designed to alter Americans’ relationship with the federal government.
Advocates of Obamacare were utterly disconnected from Americans’ concerns about the bill—most especially their concern that it violated the Constitution. Nancy Pelosi was surprised when a reporter asked what part of the Constitution justified a mandate on American citizens to purchase a consumer good or service: was this man serious? Her press spokesman later clarified, lest there be any confusion, that constitutional questions were not serious questions.
But that was not a satisfactory answer for Americans. They pressed Members to articulate the limits of Congress’s power. If it is permissible for Congress to require Americans to purchase health insurance, could it also require the purchase of grapefruits, cars, or homes? Congressman Pete Stark explained that there are no limits on Congress: “I think that there are very few limits that prevent the federal government from rules that would affect your private life… the federal government can do most anything in this country.”
As Robert Moffit explains in “Why the Health Care Law Has Sparked a National Debate Over First Principles,” Obamacare, at its core, alters the relationship between the individual and the federal government: it undermines liberty and promotes dependency. Indeed, much of Americans’ discontent with Obamacare focused “on the federal imposition of an unprecedented individual mandate to purchase a federally approved health insurance policy, but the law was pregnant with bureaucratic control over one-sixth of the economy, including the minute details of health care financing and delivery.”
In addition to changing the relationship between the individual and the federal government, it alters the relationship of the states to the federal government. Obamacare is a direct threat to American federalism. It promises to reduce the states to mere instruments of federal health policy. Specifically, the requirement for state-based health insurance exchanges represents a grave threat to states’ ability to govern. These exchanges serve as the means by which individuals and businesses purchase federally standardized health insurance plans. Such exchanges determine eligibility for government subsidies for insurance, administer the distribution of those subsidies, and facilitate enrollment in Medicaid. If states refuse to set up the exchanges or are unable to do so by 2014, then the Secretary of Health and Human Services will impose them and deprive states of any independent authority to run them. If state officials want to implement something different from the exchanges—perhaps something better—they must request a waiver from the Secretary of Health and Human Services.
At the most basic level, Obama care is not a law. Although both houses passed the same piece of legislation, and the President signed it, there is no rule of action in the Patient Protection and Affordable Care Act. What you have is a 2,700 page bundle of delegations to a plethora of existing and soon-to-be-created administrative entities. These agencies, staffed with expert bureaucrats, will create the regulations and rules of action that will govern our lives. As Moffit explains, “we are finding out what’s in the law each and every day, ranging from genuinely odd outcomes to the standard, garden-variety unintended consequences that especially bedevil health policy.” Nancy Pelosi was correct when she predicted that we would only know what was included in the bill once it was passed.
Americans did not see Obamacare as a fabulous new entitlement with almost magical cost-saving, deficit-reducing abilities. They rightly saw it as a “narrowly partisan, hastily drafted legislative monster affecting every citizen and rushed through a flawed process to meet artificial political deadlines.” This is not the quality of legislative decision-making befitting the American people, their republic, or our first principles.