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ObamaCare’s Relentless Creation of Second-Class Citizens (Part V)

Lambert Strether takes a look at Obamacare and how it is creating an imbalanced system underneath the guise of equality.

And we go to Happyville, instead of to Pain City.

–Thomas Pynchon, Gravity’s Rainbow

In this series, we’ve been looking at how ObamaCare, through its inherent system architecture, relentlessly creates first- and second-class citizens; how it treats people who should be treated equally unequally, for whimsical or arbitrary reasons. It’s all in the luck of the draw! If you live in the right place or have the right demographic, you go to Happyville. If you don’t, you go to Pain City.

We’ve looked at the whimsical differences between the citizens of Libby, MT, and all other citizens; the banked and the unbanked; those herded into Medicaid and those who are not; the arbitrary distinctions between creatures of the Beltway and all others, between the covered and the not covered, and between those who will be marketed to, and those who will not; the sheer bloody randomness of relying on credit reporting agency data for income validation; and discrimination based on jurisdiction and geography. In this installment, I’d like to look once more at geographical discrimination, give an update on the creatures of the Beltway, and look at “churn.”

First, on geographical discrimination, this from the Portland Press Herald:

An Aroostook County resident who buys a health care plan on the new federal insurance exchange could pay $1,000 more per year in premiums than a Portland resident for exactly the same coverage, according to information released Wednesday by the Maine Bureau of Insurance.

The insurance industry lobbied for the changes, arguing that it costs more to deliver health care in rural areas. The legislation made it easier to charge different rates based on which county a buyer lives in starting in 2011.

$1000 is a lot of money! How can this differential possibly be justified in a program that’s supposedly there to aid citizens? It costs the Post Office more to move the mail from Aroostook County, but a first class stamp costs the same nationwide. We don’t change Social Security benefits by where people live. So why health care?

Answer: Because Obama and the Democrats had one key goal in designing ObamaCare: To preserve the health insurance industry. (As we all know, Liz Fpwler, a Wellstone VP on secondment to Max Baucus’s office as chief of staff, wrote the bill.) If that’s your goal, regional variation discrimination by geography makes perfect sense. However, if health care is a right — and, to be fair, Obama does occasionally makes a rhetorical gesture in this general direction — geographical discrimination makes no sense at all. Unless you want to hollow out rural Maine, of course. So, if you live in the County, board the train to Pain City. And if you live in Cape Elizabeth, you’re already in Happyville!

Next, on creatures of the Beltway. First, I should say that I really don’t want to trash Congressional staffers, especially since the worse we pay them, the more likely it is that only rentier spawn will work on the Hill. I also know that Congressional staffers are not richly paid, and that free distribution of frozen Taco Bell food-like product is an event for them. That said, special treatment for creatures of the Beltway is exactly what’s going on, and Obama’s personally responsible it. Here’s the original problem statement from NC:


Dozens of lawmakers and aides are so afraid that their health insurance premiums will skyrocket next year thanks to Obamacare that they are thinking about retiring early or just quitting.

The fear: Government-subsidized premiums will disappear at the end of the year under a provision in the health care law that nudges aides and lawmakers onto the government health care exchanges, which could make their benefits exorbitantly expensive.

Democratic and Republican leaders are taking the issue seriously, but first they need more specifics from the Office of Personnel Management on how the new rule should take effect — a decision that Capitol Hill sources expect by fall, at the latest. The administration has clammed up in advance of a ruling, sources on both sides of the aisle said.

[T]his “problem,” when push comes to shove, will be “resolved” in exactly the same way that the problem of flight delays from laying off controllers during the ongoing sequester was resolved: Congress immediately put those controllers back to work, because they wanted to get back to the district as fast as they could. Nothing else changed. So, on ObamaCare, the solons and the staffers will make sure they get taken care of, and put the rest of us on the bus to Pain City.

Which — a call so obvious I can’t in good conscience take any credit for making it — is exactly what happened. Politico:

Lawmakers and staff can breathe easy — their health care tab is not going to soar next year.

The Office of Personnel Management, under heavy pressure from Capitol Hill, will issue a ruling that says the government can continue to make a contribution to the health care premiums of members of Congress and their aides, according to several Hill sources.

Just Wednesday, POLITICO reported that President Barack Obama told Democratic senators that he was personally involved in finding a solution.

Obama’s involvement in solving this impasse was unusual, to say the least.*

And let’s be clear about the problem that Obama personally solved. Forbes:

Because most Congressional staffers are poorly paid, but are paid enough to not have eligibility for the Obamacare subsidies that low-income Americans will receive, losing their current health insurance subsidies would be a big financial blow. Many members fear that their staffers would leave for better-paying jobs in response.

As has been repeatedly pointed out, there are millions of the working poor who are in an identical situation: “[P]oorly paid, but are paid enough to not have eligibility for the ObamaCare subsidies.” So, why don’t Congressional staffers just pay the penalty in the first year, and hope things will get more sane, like the rest of us poor schlubs? Well, basically, because they’re first-class citizens, on whose behalf Obama will bestir himself to get personally involved.** And first-class cities go to Happyville, while the rest of us go to Pain City.

Finally, let’s look at “churn.”

Under the law, if a person’s annual income is below 138% of the federal poverty level — or about $15,850 — he or she qualifies for coverage under the Medicaid expansion.

This is not correct. You do not “qualify” for Medicaid in the sense that you have the choice of refusing it. You are forced into Medicaid, on the basis of your income.

If a person’s income is between 138% and 400% of the federal poverty level, he or she qualifies for federal tax subsidies to purchase private coverage through the state insurance exchanges.

However, normal life events — such as getting married or divorced, having children or taking a second job — can alter an individual’s income and push him or her back and forth between the two coverage levels, according to experts.

According to a 2011 study published in the journal Health Affairs, income fluctuations under the new law next year could produce eligibility shifts between Medicaid and subsidized coverage through the exchanges for as many as 28 million people.

Researchers found that those most at risk for fluctuating coverage are seasonal and hourly workers, as well as young adults who are not covered by their jobs or their parents’ health plans.

Health care officials who work with large Medi-Cal populations say fluctuations in eligibility cause the quality of care to decline and the cost of care to increase from added administrative expenses. Medi-Cal is California’s Medicaid program.

(To this I would add that if you’re over 55 and forced into Medicaid, your expenses will be clawed back from your estate.)

So, if you’re a seasonal or hourly (read: poorly paid) worker, or young, you’re faced with the stress of integrating into a new health care network whenever a “major life event” happens. Pain City, over and over again! So the Bible says, and it still is new…

What frosts me is that none of this suffering is needed. It’s all an inevitble consequence of ObamaCare’s system architecture. ObamaCare throws Americans into different buckets using a complex and confusing system of eligibility determination, and people inevitably get thrown in the wrong buckets, or land between buckets, or there aren’t even the right buckets for them. Adding to the mix is that buckets differ by state, both legally and in terms of insurance markets, and so what should be a simple, national system of Medicare for All instead creates second-class citizens all over the place, both within and between states.

Obama chose to go that route. Under a single payer system, where health care is a right, the eligibility paperwork is very simple. There is one form, and it’s already been filled out: Your birth certificate. And that’s how it should be.

NOTE * And since when does a President get personally involved in minor personnel matters? It’s bizarre, almost as bizarre as forcing down an airplane used by another head of state. Who does Obama think he is? The Decider?

NOTE ** Why not just go for outright feudalism, instead of mucking about with penny ante patronage deals like this? Cannot Obama have the courage of his convictions, if any?