#FullRepeal Daily Digest

The Transom: YOU WON’T BELIEVE WHAT JONATHAN GRUBER SAID [About the Halbig case, specifically the law's distribution of tax credits to only state-based exchanges]

• …[Obamacare architect Jonathan Gruber] was on MSNBC just the other day [and said] “Chris, it is unambiguous this is a typo. Literally every single person involved in the crafting of this law has said that it`s a typo, that they had no intention of excluding the federal states. And why would they? Look, the law says that people are only subject to the mandate if they can afford insurance, if it’s less than 8 percent of their income. If you get rid of these subsidies, 99 percent of the people who would get subsidies can no longer afford insurance, so you destroy the mandate. Why would Congress set up the mandate and go through all that political battle to allow it to be destroyed? It’s just simply a typo, and it’s really criminal that this has even made it as far as it has.”
• I think Jonathan Gruber should take up this argument with someone who holds the opposite view: Evil Jonathan Gruber, back in 2012…“in January of 2012, Gruber told an audience at Noblis, a technical management support organization, that tax credits—the subsidies available for health insurance—were only available in states that set up their own exchanges. Here’s what Gruber says:”
• “What’s important to remember politically about this is if you're a state and you don’t set up an exchange, that means your citizens don't get their tax credits—but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. I hope that that's a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges. But, you know, once again the politics can get ugly around this.”
• [RELATED] Forbes: Obamacare Architect Jonathan Gruber: "If You're A State And You Don't Set Up An Exchange, That Means Your Citizens Don't Get Their Tax Credits
  • Gruber doesn’t just acknowledge the conditional feature of the PPACA’s tax credits. He also supplies a plausible purpose for that feature (there were people in Washington who either wanted to “squeeze the states to do it,” or saw the law as directing them to do so). He describes the mechanism by which this provision achieves that purpose (taxpayers will pressure their state officials to create Exchanges so they can receive tax credits). He acknowledges that the conditional nature of the tax credits sits perfectly well alongside the law’s requirement that the federal government establish an Exchange within states that do not (providing another refutation of the argument offered by Yale law professor Abbe Gluck that these provisions are somehow in tension). He even explains why the Obama administration might try to ignore this part of the law (the politics of the PPACA “can get ugly,” and the lure of tax credits might not be enough to induce states to cooperate).
  • Gruber is not a member of Congress, so this isn’t direct evidence that Congress intended to offer tax credits only in state-established Exchanges. (The procedural path the bill took through Congress is dispositive evidence of that.) But he may be the next best thing.
  • Gruber was an architect of both the PPACA and its Massachusetts precursor, “RomneyCare.” In 2009 and 2010, he was a highly paid advisor to the Obama administration during the congressional debate that produced the PPACA. According to the New York Times, “the White House lent him to Capitol Hill to help Congressional staff members draft the specifics of the legislation.”… Gruber boasts of having written part of the PPACA. He boasts to the Times, “I know more about this law than any other economist.” He’s probably right about that.

Washington Post: Varying health premium subsidies worry consumers

• Subsidies are important to making premiums under the new health care law affordable. About 87 percent of the more than 8 million people who signed up for coverage under the law received subsidies, which are paid directly to the insurance company on behalf of individual consumers, according to data from federal health officials. Consumers pay the difference directly to the insurance company each month just as they do with private insurance.
• The differing subsidy calculations are part of a mountain of data conflicts affecting at least 2 million people who signed up for coverage in the new health insurance exchanges. Most of the discrepancies involve important details about income, citizenship and immigration status — which affect eligibility and subsidies.
• Some supporters of the law fear low-income consumers will owe the government money because their subsidy was incorrect. Federal health officials have repeatedly stated that the IRS will have the final say, regardless of what figures were generated on healthcare.gov. The IRS can deduct the amount from consumers’ tax refund or tell consumers they owe the government money. Or, conversely, consumers could receive money back if they took too low of a subsidy.

The Wall Street Journal: Hospitals, Insurers Say Subsidies Rulings Further Confuse the Issue Consumers Returning to Marketplaces Face Greater Doubt [shocker: those who stand to profit from Obamacare's subsidies are concerned that if the law gets implemented as it should be that their subsidies could go away in a majority of states. Expect them to exert heavy pressure on states to continue their exchanges/subsidies/penalties no matter how the Courts decide the case. We must be ready to counter them and say that such a ruling would offer states a lifeboat for their citizens/businesses off of the sinking SS Obamacare]

• Health-industry officials said Tuesday's dueling court rulings over federal health-law subsidies set the stage for another bout of confusion as consumers return to marketplaces this fall to shop for next year's coverage.
• Insurers including Aetna Inc.,Molina Healthcare Inc.  and others said they would nonetheless move forward with plans to sell coverage in the marketplaces—including in states that use the federal exchange where subsidies are in question. And many said they would seek to reassure consumers that, at least for now, nothing has changed.

Morning Consult: Republicans Will Run On An Obamacare Replacement in 2016 – Will Democrats?

• But whatever the ultimate outcome for Halbig, the case serves as a reminder of the uneven ground on which Obama’s health care law is likely to be standing over the next two years. Whether facing challenges in the courts, or in implementation, as we saw in the GAO’s security report this week, or simply as a matter of political approval, Obamacare is going to be a subject of uncertainty in 2016, and its survival will depend on who wins the election, as I wrote here last month.
• One of the lazier memes of Democratic politicians and a few too many members of the media over the past several years has been the myth that Republicans have no alternative to Obamacare. This is the sort of thing that doesn’t pass even the most basic assessment of accuracy in reporting – here is a list of the health care reforms introduced by Republican House members in 2012, and here’s one for 2013. While their plans vary in scope, there are eight things Republicans generally agree about when it comes to health care reform:
  • They want to end the tax bias in favor of employer-sponsored health insurance to create full portability, either through a tax credit, deductibility, or another method;
  • They want to incentivize the reform of medical malpractice laws, likely through carrot incentives to the states;
  • They want to allow for insurance purchases across state lines;
  • They want to support state-level pre-existing condition pools;
  • They want to fully block grant Medicaid;
  • They want to shift Medicare to premium support;
  • They want to speed up the FDA device and drug approval process; and
  • They want to maximize the consumer driven health insurance model, making high deductible + health savings account plans larger and more attractive.
• For the Democratic nominee, however, the challenge of running in defense of Obamacare could prove more difficult than might be anticipated. Obama’s law is sacrosanct for some factions of the Democratic Party. Many observers have cited a variety of poll data showing that Americans want to fix Obamacare as opposed to repealing it or keeping it as-is. But those “fixes” are largely vague at this juncture, thanks to the administration’s decision to enforce aspects of the law as it sees fit.