Two years ago, everything about Obamacare was in the future. Recall the revealing comment at the time by then-Speaker Nancy Pelosi (D–CA) that Congress had to pass the legislation to see what was in it. Now that the disputed law is in its implementation stage, Americans are beginning to see what is in it and what it means for them. Welcome to the future.
The Patient Protection and Affordable Care Act, better known as Obamacare, is the centerpiece of the current progressive agenda. At its core is the requirement for individuals—under penalty of law—to buy health insurance. As we have argued before, this requirement is unprecedented and unconstitutional. The concern is that if government can regulate inactivity, it can do anything and everything.
We now see how this new regime will operate. Massive regulatory authority over one-sixth of the American economy is transferred to a collection of more than 150 federal agencies, bureaus, and commissions, along with an unprecedented delegation of power to the Secretary of Health and Human Services. As a result, key policy decisions are given over to bureaucrats whose “rules” in the guise of “regulations,” mostly unaccountable and invisible to the public, have the full force and effect of laws passed by Congress.
This new bureaucratic reign, its arbitrary discretion, and the resulting potential for cronyism can be seen in Obamacare’s earliest actions. Even before the law is fully implemented, administrators have granted almost 2,000 waivers (mostly for union and business friends) to its own health care regulations. One whole program (the CLASS Act, Obamacare’s long-term care insurance plan) has been unilaterally cancelled as completely unworkable—but kept on the books for possible future implementation.
We now have the first real taste of what is to come. Not only do we have to buy health insurance, but now they’re telling us what that health insurance will look like.
It turns out that under Obamacare—earlier denials to the contrary notwithstanding—all insurance plans must cover, at no charge, abortion-inducing drugs, contraceptives, sterilization, and patient education and counseling for women of reproductive age. Religious employers such as Catholic hospitals, Christian schools, and faith-based pregnancy care centers will have to provide and pay for such coverage for their employees regardless of their religious beliefs. Although religious institutions vehemently objected that the proposed rule would force them to provide services that as a matter of faith they find morally objectionable, Health and Human Services issued the final rule in its entirety and without the slightest change.
This is not a one-time exception to the rule of Obamacare; it is the establishment of the rule itself. One can only imagine what life will be like when the Independent Payment Advisory Board (IPAB) begins rationing health benefits to reduce Medicare spending. It is not the details in Obamacare that are the real problem but the form of governance it establishes, by which unelected experts are empowered to make the rules as they go along.
What is happening has little to do with health care or even public policy and everything to do with the role of government in the most immediate and intimate matters of our lives. All is subject to government control, regulatory dictate, and administrative whim. Nothing will be allowed outside of the new regulatory scheme: no independent state programs, no individuals or businesses permitted not to participate, no true private market alternatives.
There should be no surprise here. This is the heart of the progressive project. It is what happens when a model of government focused on determining outcomes, despite good intentions, finally acquires the unlimited authority to reshape society to its bureaucratic blueprint.