Until King Dumb Come

Until King Dumb Come

ObamaCare’s industry allies shake the tin cup at the Supreme Court.

From the Wall Street Journal

One goal of ObamaCare was to compel the private companies of the U.S. health industry to become adjuncts of the federal government. In that respect the law is succeeding beautifully, judging by the flood of amicus briefs on behalf of the White House in the Supreme Court challenge to ObamaCare’s illegal subsidies.

King v. Burwell is pulling everybody out of the woodwork from the big hospitals to the various physician lobbies to the major insurers. These business supplicants have little and often nothing to contribute on the legal merits. But they do want the Justices who might be inclined to obey the law’s text—which limits subsidies to exchanges established by states, not the 36 run by the feds—to know the woe that withdrawing the subsidies would visit on patients and especially on their corporate welfare.

Shutting off the federal-exchange subsidy spigot would be “a disaster for millions of lower- and middle-income Americans,” the American Hospital Association and the Federation of American Hospitals team up to write. “The point cannot be overemphasized: This is no abstract case about principles of statutory construction. Petitioners’ position, if accepted, means many more people will get sick, go bankrupt, or die.”

Yet amid these killing fields, the hospital lobbies would be remiss if they didn’t ever so delicately mention that it would be a disaster for their own bottom lines. Providers endorsed the law and traded $155 billion in cuts to hospital reimbursement for the payola of many more government-insured patients. “An ACA [Affordable Care Act] without subsidies would leave hospitals unable to make up the loss in their funding,” they write.

Hospital Corp. of America also invokes this quid pro quo, as if the Court must abide by Faust’s bargain. But HCA—the largest hospital chain in the U.S. with 155 acute-care facilities and 37,000 affiliated doctors—adds that the subsidies should also remain as a consolation prize for destroying the old individual insurance market.

The company reports that among the 51,000 patients HCA saw in 2014 who are now enrolled on a federal exchange and were previously treated by the company, some 56% were insured at the time of their prior treatment. In other words, ObamaCare’s plans mostly displaced private coverage. But HCA argues that, “This population would find it substantially more difficult than before the ACA to obtain coverage if the subsidies are eliminated” (their emphasis).

What HCA means is that without the offset of the subsidies, consumers will be exposed to the full cost of ObamaCare’s rules and mandates. As a thought experiment, the company posits “a waitress in Jacksonville, Florida” who earns $21,230 a year. Under ObamaCare, she can now obtain a relatively generous plan for $96 a month out of pocket, but the cheapest plan without subsidies would be $198 a month, or 11% of pre-tax income. “This is not affordable coverage,” HCA writes.

So instead of trying to eliminate the regulations that overprice insurance, the chain wants the Court to bless the federal subsidies that the law never authorized.

This Stockholm Syndrome is also rife among insurers, which also favor a taxpayer discount for their products. America’s Health Insurance Plans notes that 85% of ObamaCare enrollees claim subsidies, which on average fund 76% of their premiums. Cancelling this “would make health insurance less affordable—the precise result the tax credits were intended to prevent.”

Sometimes this special pleading becomes free association. The National Association of Community Health Centers writes that, yes, community health centers “provide critical entry-level jobs, training, and career-development opportunities for individuals in disadvantaged communities.”

HCA even argues that “Congress was acutely concerned with the health care needs of women in enacting the ACA,” and, thus, “On the federally facilitated Exchanges, by contrast, 65% of HCA’s patients are women, outnumbering men nearly two to one.” Kudos for merging gender and entitlement politics.

But our favorite is the brief from the American Academy of Pediatrics and other provider trade groups: “Petitioners’ reading of the phrase ‘Exchange established by the State’ would thus unravel the core reforms of the ACA—reason enough to reject their view.” Forget about the plain language of the statute, never mind fidelity to the law. National health care is too important for such niceties.

These irrelevant arguments belong to the larger lobbying campaign to intimidate the High Court into disregarding the law to rescue the political project of ObamaCare. If the Justices must do so, we hope they find a better reason than the health industry’s self-interest.