Epstein: The Obamacare Quagmire

"Now that the Supreme Court has held President Obama’s Patient Protection and Affordable Care Act (ACA) constitutional, mounting evidence suggests that the statute’s most ardent defenders may well come to rue the day," writes constitutional law expert Richard Epstein.  Why? Because advocates "failed to take into account the old and powerful law of unintended consequences." Epstein maintains the law will hurt the very people it's supposed to help.

• Federal and state officials must grapple with implementing the law whose internal complexity and flawed design make it a program that was built to fail.
• The fine print of the ACA could leave dependents of millions of low-income employees without coverage from either an employer or an ACA insurance exchange.
• Many states may choose not to set up insurance exchanges at all, which would leave  low-income residents in those states with no access to the subsidies proponents promised them.
• The ACA requires every insurance plan cover, among other things, "ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic disease management, and pediatric services" [even for plans purchased by 21-year-old single, healthy, childless males]. 
• Insurers can no longer require insurance applicants to disclosed their health conditions and have no way to determine their relevant risk or estimate the potential cost in future care.
• Fearing that private insurance companies will be driven out of business by the ACA before states exchanges are up and running, the government has issued more than 1000 employer waivers involving over 3 million people.

None of this should come as a surprise. The ACA was sold with a set of promises that were not sustainable. President Obama trumpeted his program with reassuring words in June 2009: “No matter how we reform health care, we will keep this promise: . . . If you like your healthcare plan, you will be able to keep your healthcare plan. Period. No one will take it away. No matter what.” He has repeated that vow since. As David Hyman and I have shown, the ACA violates that promise in multiple ways.

The Act’s potential disruptions are not just confined to people who are forced into the exchanges; it extends to all individuals regardless of how they procure their healthcare insurance. All that can be said with confidence is that, thus far, the ACA has not been able to defeat the law of unintended consequences. Whether this nation will be able to extricate itself from the ObamaCare quagmire remains to be seen.