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The Left doesn't seem too sure how to deal with the incipient ObamaCare resistance. But it's clear they don't like it.
That movement, launched by FreedomWorks last month, and quickly joined by other groups (including the Citzens' Council for Health Freedom and Young Americans for Liberty) urges Americans to do what’s best for them rather than blindly go into the government-run exchanges.
Instead of buying what in many cases will be overpriced health insurance, we're urging folks to “burn your ObamaCare card": skip the exchange, pay the fine, defend your freedom.
If enough people do this, it will hasten the collapse of the government-run exchanges and thus the replacement of ObamaCare with patient-centered care.
Progressives are reacting to this unexpected resistance in various ways, including disgust (Mother Jones, Daily Kos), mocking disbelief (Stephen Colbert), angry disbelief (Salon), personal affront (Huffington Post). policy denial (Slate) and, my favorite, saddened bemusement (Ezra Klein/MSNBC).
If people don’t get their insurance through an ObamaCare exchange, these folks seem to assume, they’ll have to go uninsured, and thus go without needed health care, or else be financially saddled with costly medical bills. And anyone who advocates that must be a “nihilist.”
The most sophisticated left-wing responses (New Republic, Washington Post) have denied our argument that, under this law, you can wait till you're sick to sign up for insurance. No, they claim, you can't.
Really? Why not? Because of something called open season.
Open Enrollment Periods
Under ObamaCare, we will be able to sign up for government-approved health insurance only during two months at the end of each calendar year. Open season will run from October 15 through December 15 each year (except for the first year, when, it will run for six months, from October 1 through March 31).
As the Washington Post’s Sarah Kliff puts it:
The Affordable Care Act has an open enrollment period, which is the time frame when Americans can enroll in health plans on the [exchange] marketplace. The whole point of this feature is to prevent people from signing up for coverage en route to the hospital.
Outside of “open season,” people with preexisting medical conditions who need insurance will be out of luck.
Or so we're told. The truth is more complicated.
People who skip the exchange will actually have a number of perfectly legal alternatives for handling their medical bills, including: keeping their existing coverage (for example, job-based coverage, if their employer offers it); relying on personal savings; relying on friends and neighbors (as, for example, by joining a “health care sharing ministry,” a sort of faith-based cooperative for sharing medical bills); paying bills in installments; negotiating bills down with a willing doctor or hospital; or -- most important -- buying health insurance outside the exchange.
Yes, we’re still allowed to buy insurance outside the government exchange. For now, at least.
Here's where the argument gets interesting. The open season rules apply to the entire individual market, both inside and outside the local exchange.
The purpose of this is to prevent undue "gaming" of the exchanges, i.e., younger and healthier folks tending to gravitate to non-exchange plans, while older and less healthy folks gravitate into the exchange. By self-selecting out of the local government "marketplace," younger people could destabilize it, causing it to collapse.
So, in effect to protect the exchanges from competition, the government feels it must force the private alternatives to operate under the same "open season" rules as itself.
But, as I said, the story is actually a bit more complicated than that. And the upshot is that it isn't quite accurate to say that "burning one's ObamaCare card" will lead to being uninsured or at risk of personal financial catastrophe.
Counterpoint 1: Special Enrollment Periods
There are several exceptions to open season. You can get around the open season rules, at any time of year, through one of the following loopholes:
a. If you obtain a job that offers affordable health benefits, open season doesn't applpy to you. This is because, if an employers offers coverage, he has to offer it to everyone in the group equally, more or less from the time they’re hired.
b. If you live in a state that creates one or more additional open periods, you can use them to get around the federal open season. As Timothy Jost, the Left’s favorite expert on the Unaffordable Care Act, explains:
The ACA authorizes HHS to prescribe open enrollment periods both in and outside of the exchange in the individual market. [HHS] requires an annual, end of the year, open enrollment period … [But] States are permitted to establish more frequent open enrollment periods. [Emphasis added.]
(States that want to be more “compassionate” than the feds could, for example, create an additional open season that fills in the entire gap between federal open seasons.)
c. You can also trigger a “special” enrollment period for yourself, by reporting certain “life events.” As Sarah Kliff explains:
There are also special enrollment periods to accommodate those who have a major change in life circumstances. If a mother gives birth to a baby, for example, the child can enroll in coverage outside the open enrollment period. If the subscriber has a significant change in income, he or she will also be able to switch to a different (potentially more affordable) health plan.
So within federally defined limits, you can obtain insurance at any time of year, if your place of residence changes, or if your marital status changes, or if your employment situation changes, or if your income changes, or -- I love this one -- if either HHS or your local exchange bureaucracy decides to let you in as a sympathy case (“exceptional circumstances”).
But other than that -- no exceptions!
Counterpoint 2: Non-Compliant Coverage
What if you miss open enrollment and don’t have a "qualifying event"? According to eHealth (a private, online health insurance exchange that has existed since long before ObamaCare, and the very existence of which shows why we don't need government exchanges, but that's another story):
You may be able to purchase a non-compliant plan or a short-term health insurance plan, but these won’t meet the standards of the Affordable Care Act and their benefits will likely not be as comprehensive. [Emphasis added.]
In other words, it is legally possible to obtain non-exchange coverage that may not meet all of ObamaCare's bells and whistles, but which might fit your needs just fine.
Counterpoint 3: EMTALA
Is the Left okay with people “dying on the sidewalk”? That would seem to be the logical implication of a hard-and-fast open season, wouldn't it? Well, at least until one remembers EMTALA. That’s the federal law passed in the 1980s that requires hospital emergency rooms to screen and stabilize every person who shows up, regardless of ability to pay. Obviously, EMTALA softens the blow of open season. It means nobody has to die on the sidewalk. It also softens the blow of burning one’s ObamaCare card.
Counterpoint 4: Hypocrisy
How can progressives call ObamaCare resisters “nihilists” for urging John Q. Public to voluntarily skip the exchange, while giving themselves a pat on the back for involuntarily barring the same John Q. Public from insurance (inside or outside the exchange) when he applies for coverage one day too late. The effect for Mr. Public would appear to be identical.
The difference would seem to be in the motives of left and right.
In urging resistance to this whole coercive scheme, conservatives want to help Mr. Public do what’s best for him, both in the short run (maximize control of his own health care decisions) and in the long run (hasten the collapse of government-run health care, which poses a threat to everyone’s health).
The progressives, by contrast, appear to be trying to force Mr. Public to do whatever they think is best for him, regardless of his actual needs or wants, so they can make their carefully constructed system "work."
You have to wonder about progressives. Are they really willing to deny health insurance to anyone who really needs it? If so, aren’t they implicitly admitting they care about something more than about people having health insurance?
Could that “something” be, for example, a desire for power and control?
But we're the "nihilists."