ObamaCare five years later

JOHN BREHANY writes that Catholic business leaders are still burdened by ObamaCare . . .

John Brehany

by John Brehany

The Patient Protection and Affordable Care Act (aka ObamaCare) is five years old. Legatus members should continue to learn about and respond to this flawed legislation.

Where do we stand at this point? It’s hard to say. The Administration has not provided regular and reliable data about implementation. And the Galen Institute has identified 49 significant changes in ObamaCare (30 by unilateral executive action) since 2010. Most have involved delays or waivers of mandates, deadlines and fees. Another significant change — providing federal subsidies in states without insurance exchanges — is under review by the Supreme Court.

After these caveats, it’s clear that there has been some progress in providing access to health insurance. In 2014, a total of 14 million people obtained new access to health insurance (5.8 million bought health insurance and 8.7 million were added to Medicaid). The net increase, however, was closer to 10 million due to millions losing their employment or private insurance. Significantly, only half of those buying insurance at Healthcare.gov were uninsured, and only one-third of those eligible for subsidies signed up. This lack of participation should be concerning. In 2014, health insurance premiums increased an average of 49% despite President Obama’s pledge that families would see an average $2,500 reduction in annual health insurance premiums. For now these increases are being masked by subsidies.

What will we be facing? The real impact of ObamaCare will be felt in the next few years. First, the employer mandate is set to be enforced in 2016. Employers have already cut employee hours and reduced benefits, and this trend is likely to continue. The disruption in employment-based health insurance could be greater than that in the individual market in 2013. Second, the full costs of ObamaCare will become more apparent in 2017. The Administration has been tapping a $25 billion reinsurance fund to backstop health insurance companies’ losses, allowing them to keep premiums artificially low. After this fund expires at the end of 2016 and insurance companies gain claims experience with the newly insured — who are older, sicker, and poorer than originally projected — on Healthcare.gov, costs almost certainly will be much higher.

What should we do? Catholics and Catholic business leaders in particular should play a key role in proposing and enacting substantive changes to the current law as soon as the window for action opens — after a new president takes office. The Catechism teaches: “It’s not the role of the pastors of the Church to intervene directly in the political structuring and organization of social life. This task is part of the vocation of the lay faithful, acting on their own initiative with their fellow citizens” (#2442).

While being cognizant of key data and of the rules for effective political discourse, Catholic business leaders should make a compelling and comprehensive moral case for substantial changes in ObamaCare that will achieve authentic health care reform and protect essential human goods. I suggest there are at least three indispensable components of this moral case.

First, a moral case should be built on the foundation of Catholic social teachings, especially the principles of social justice and subsidiarity. We respect social justice (CCC #1928) when we ensure that the vulnerable and marginalized have access to adequate health insurance and health care. We respect the principle of subsidiarity (CCC #1883) when we ensure that decisions about health insurance and health care are made at the lowest, most local level.

Second, a moral case should be built on the dignity of the human person and on respect for fundamental human goods — above all, respect for the right to life, of conscience, and of religious freedom. ObamaCare’s sloppily written legislative language undermines longstanding protections for these rights in federal and state law. And the HHS mandate has been imposed with disregard for the religious beliefs of millions.

Third, a moral case can and should build on the strengths of the American social tradition. These strengths go beyond broad human freedom and decentralized governance to include high levels of generosity across the population. America is the most generous nation on earth. Philanthropy has been essential to building the finest and most advanced health care institutions. Legislation and taxes are necessary to protect human rights and the common good. Yet, where the welfare state is strongest, generosity of philanthropy dedicated to serving those in need is the weakest. Sound political and economic measures for health care reform should be supplemented by encouraging philanthropy.

JOHN BREHANY is the director of institutional relations at the National Catholic Bioethics Center.