RALEIGH — Now that the North Carolina legislature has sent a clear signal that it opposes both Medicaid expansion and a state-based health exchange, the state capital is abuzz with complaints and speculations.
Are Senate leader Phil Berger, House Speaker Thom Tillis, and Gov. Pat McCrory jockeying for political position? Are they trying to use state action to nullify a federal law? Are they just making an ideological statement instead of making public policy?
No, no, and no. North Carolina Republicans have long opposed Obamacare — its conception, its faulty design, its intrusion on state and private prerogatives, and its dire implications for health care markets, economic growth, and personal liberty. After Chief Justice John Roberts waffled on the constitutional question and President Barack Obama won re-election, GOP leaders recognized that immediate repeal of the legislation was impossible. But that doesn’t mean they’ve accepted Obamacare as a permanent fixture of American life.
They know, just as many liberal experts must surely know, that the bill contains so many fundamental flaws that it cannot last long in its current form. For example, the taxes on uninsured individuals and uncooperative businesses, while annoying, are too low to motivate universal compliance (that’s what made them constitutional, by the way, according to Justice Roberts). For many people, it will make more sense to pay the tax than to buy expensive, federally approved health insurance. Those Americans who do decide to take Washington up on its offer will tend to have preexisting conditions or a high likelihood of medical needs. Some will be dumped onto the new exchanges by their employers. Others will enter from the individual market, or from the ranks of the uninsured.
Parts of the private insurance market, in other words, are about to blow up. Estimates vary, but it is likely that in a few months North Carolina health insurers will release eye-popping rate increases for 2014. In the small group and individual market, the proposal will be to hike rates 100 percent or more for some customers, and maybe half that for many customers.
For some Obamacare advocates, this will come as a shock. They truly believed the original promise that the law would cut health care costs and insurance premiums. But other advocates won’t be shocked at all. They never believed in the efficacy or desirability of private health care arrangements, anyway, and see blowing up the insurance market as the necessary precondition for the subsequent adoption of Medicare/Medicaid for all.
At the state level, then, fiscally conservative governors and lawmakers have had to do their homework and understand what is really going on. They have had to learn that one reason the Obama administration desperately wants states to create their own insurance exchanges is that it will give voters multiple officials and levels of government to blame for an unpopular policy likely to become even more unpopular. In other words, Washington is playing politics with the states, not the other way around.
State officials have also had to learn that the Obama administration isn’t prepared to set up dozens of new federal exchanges this fall, anyway. Implementation delays are likely. Furthermore, they have learned that by the plain text of the Affordable Care Act, much of its architecture — taxes, credits, and mandates — are predicated on the existence of state-run exchanges. By defaulting to a federally run exchange, they may well shield their state’s households and businesses from those taxes, if current litigation by Oklahoma and other states is successful in the federal courts.
None of this constitutes nullification. It constitutes North Carolina officials exercising their due diligence, along with those of other states, to put pressure on Congress to take remedial action. Repeal is impossible while Obama is president. But Congress may find it necessary to revisit key provisions of what will soon be revealed as an unworkable law.
Is that goal worth hearing a few complaints from special-interest lobbies and some fanciful speculations by Raleigh politicos? You bet.
John Hood is president of the John Locke Foundation, which has just published “First In Freedom: Transforming Ideas into Consequences for North Carolina.” It is available at JohnLockeStore.com.