FISCAL TIMESBy Edward Morrissey
12/19/2013
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The rollout of the Affordable Care Act has provided many real-world examples of this, but perhaps none so “unintended” as the consequences discovered by the Seattle Times this weekend. Carol Ostrom, The Times’ health reporter, told the story of 62-year-old newlyweds Sofia Prins and Gary Balhorn, who weren’t exactly the models of wild, starry-eyed romantics.
Their nuptials were motivated by a stronger desire to keep their house out of the hands of the federal government, thanks to a little-known key provision of Obamacare. Their meager incomes made them eligible for a federally subsidized health plan, and their assets would be protected.
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For years, Democrats had demanded federal action to address the problem of Americans without health insurance coverage. Estimates of this population went from 14 million to 40 million during the debate in 2009-10 over the scope of the crisis and potential solutions for it.
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While those numbers sound large, a Gallup poll in late 2009 put them in better perspective, noting that 85 percent of American adults had health insurance, 87 percent of whom were satisfied with their coverage, and 61 percent satisfied with the costs. Even among the uninsured, half were satisfied with their situation, although only 27 percent expressed satisfaction about their costs for health care.
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Below that point, Americans who do not have employer-based coverage have to accept Medicaid coverage in order to comply with the Obamacare individual mandate, or pay full price for the skyrocketing premiums from private-sector insurers.
People often confuse Medicaid with Medicare, but there is a critical difference between the two programs. Medicare eligibility derives from Social Security contributions, and is a true “entitlement” program. Theoretically, coverage comes as part of the funds paid into the system, although in reality the federal government has to borrow billions of dollars to cover the costs.
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Medicaid, on the other hand, is a state-based and federally-subsidized welfare program, one that employs means-testing – which includes ownership of assets as well as income levels. Medicaid programs include conditions that put recipients’ assets remaining after death at risk for seizure to reimburse taxpayers who footed the bill for the recipient’s health care during his/her lifetime.
Unless they look at the fine print in the paperwork in Washington and other states with similar asset-forfeiture regulations, any assets they own will not pass to their heirs but to the state instead.
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Prins and Balhorn are hardly alone in Washington. Adults between the ages of 50-64 account for 18 percent of the enrollments in the state’s Apple Health Medicaid program, and the seizure regulations apply in their cases for those 55 and older. The state exchange uses only income levels to means-test Washington applicants for the program, which means most of them will have no idea that their assets are at risk until it’s too late.
“People will think this is wonderful, this is free insurance,” Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, said in an interview. “They don’t realize it’s really a loan, and is secured by any property they have.”
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That’s one of the problems of Obamacare itself – the perception that it’s a free lunch. Even those who do qualify for subsidies get that only through the collection of a myriad of taxes imposed by Obamacare. Those taxes apply to employers, insurers, and medical-device manufacturers, which drive up the costs for consumers and workers in indirect ways. It’s a shell game--not a reform that actually drives costs down. Instead Obamacare only masks price increases through dishonest opacity.
That might still have been controversial and would not have been cost-free by any means, but it would not have fatally undermined a system that worked for 85 percent of Americans and misled many of the rest into risking their estates without any warning that government would strip their heirs of family homes.
Targeted and modest solutions minimize unintended consequences, and allow for more speed and efficiency when they do arise. Obamacare will serve for decades as the cautionary tale when arrogance rules over modesty and common sense.