Health Care Reform’s Mandate Madness

Mandate Madness

At the beginning of the Obama presidency we were promised the “most transparent administration in history.”

However, House Speaker Nancy Pelosi stated concerning one of this president’s most aggressive initiatives, The Patient Protection and Affordability Care Act (PPACA) also known as Obama Care, that “we must pass the bill to see what is in it.”

Now that the bill has passed, this massive reform package continues to unveil more surprises than a bursting piñata, in what many are calling an overt and serious attack on individual freedom and a demolition of the Constitution.

Bloated with power, the federal government is simultaneously taking aim at state’s rights, religious rights and even the fragile condition of Medicaid—which is essentially already bankrupt.

Writing about Obama Care mandates for the Stanford University-based Blog “Ricochet,” Dr. Richard Epstein said, “Government fiat will drive companies [and individuals] into bankruptcy.”

But a show-down is coming.

Attorneys General from 28 states have challenged the constitutionality of Obama Care, and on March 26-28 of this year, the Supreme Court will decide who is right.

Arguments before the Supreme Court are:

  • The Individual Mandate:  The minimum coverage provision; forcing all citizens to purchase prescribed healthcare or be penalized. If the Supreme Court finds in favor of Obama Care, those who refuse to purchase will in essence be forced to comply anyway.
  • The Severability Clause: Determining whether and how much of the law will remain in force if other provisions, like the Individual Mandate, are struck down.  This clause stipulates that if one part of an Act is negated, so is the entire Act.
  • The Anti-Injunction Act: This act prohibits lawsuits from stopping the implementation of a tax before the tax has been imposed. This undermines the freedom of opposition.
  • The Medicaid Mandate: Determining whether Congress exceeded its powers by coercing the states through its massive expansion of the state Medicaid programs.

Additional facts about the Mandates

The Medicaid Mandate

In terms of the new Medicaid mandates, many state programs are already dealing with large deficits of hundreds of millions of dollars.  Yet, they must now begin following even more stringent participant eligibility requirements, including:

  1. the inability to reduce the benefits of existing participants;
  2. the inability to actively confirm a participant’s eligibility status; and
  3. the requirement to include more benefits.
  4. Some states are also adding thousands of participants to their rolls monthly involving even more costs that are impossible to quantify.

To supposedly reduce costs, Obama Care suggests states develop insurance “exchanges” that include groups of carriers and provide large group rates.  But these exchanges are still replete with their own “Obama-lite” mandates that increase states’ expenses.

It is important to note that if states choose to opt-out of the Medicaid mandates, the states will be penalized by having government matching funds withdrawn.  The states would also still be responsible for Medicaid participants already enrolled and would still be taxed for the provisions of Medicaid.

The Individual Mandate

One of the main arguments the Administration has been advancing in court to support the constitutionality of the penalty imposed on those who do not buy health insurance, is that the penalty is merely a tax.

But on February 15th the president’s Director of the Office of Management and Budget, Jeffrey Zients, threw a wrench into the works for the Department of Justice’s (DOJ) argument for a tax when he said the individual mandate “was not a tax.”

Adding to the confusion, the president has repeatedly assured a nervous business community and public that “no one making under $250,000 will see a tax increase.” He didn’t mention penalties.

Whether by tax or penalty, the most important question is, can Congress require every American to purchase health insurance?

In a Washington Post article entitled, “Constitutionality of Health Insurance Mandate Questioned,” David Rivkin says, “In short, no.”   “The Constitution assigns only limited, enumerated powers to Congress and none, including the power to regulate interstate commerce or to impose taxes, would support a federal mandate requiring anyone who is otherwise without health insurance to buy it.”   He goes on to say, “The Senate version of the individual mandate envisions that failure to comply would be met with a penalty, to be collected by the IRS.  This arrangement, however, is not constitutional either.”

More “Sticker Shock” to come

By design, significant and costly parts of Health Care Reform are scheduled to take effect over the next few years.  And as we are now seeing (because the details are truly becoming more transparent), these “reforms” will continue to create shock and awe for the consumer.

Shock, because of the blatant attack on the very heart of federalism (separation between the federal government and the sovereign rights of states to govern, as they see fit) built into the Constitution as a guard against the federal government’s over-reach.

Awe, because as the details of more mandates unfold—the boldness of governments’ over-reach is stunning.

Didn’t we already fight a similar battle against the arrogant and out-of-touch King George more than 200 years ago?

Yet some provisions of Obama Care are uncomfortably familiar including:

The Medicaid Mandate:  Confiscatory taxation; violates separation of powers

The Individual Mandate:  An unconstitutional violation of the Commerce Clause which involves the balance of power between the federal government and the states.

Contraceptive Mandate: Violation of the First Amendment; free exercise of religion forcing religious institutions to provide contraception, sterilization and abortion through employees insurance

The administration’s recent “compromise” on the contraceptive mandate shifted responsibility for payment of these services from religious institutions to the insurance companies.

But remarking on this compromise, Chris Smith (R) NJ said, “Who pays for the insurance policy?  The religious employer.”

Being aware of these attacks on our rights and the fundamentals of our Constitution, means we can choose to fight.  But the greater question is, what will an emboldened federal government take aim at next?

It is easy to be overwhelmed by this growing barrage, and there’s always the temptation to just duck and pray. But if we bow to this power intoxicated bully now, we may not be able to stand again.  Bullies only back down when they are overcome by a stronger force – and so, we must take on this leviathan of the federal government now.

About Dianna Lightfoot

A member of the Palmetto Liberty PAC board, Dianna Lightfoot is the founder and president of the National Physicians Center (NPC). She has also worked as Executive Vice President of the South Carolina Policy Council and Director of the Alabama Policy Institute’s Physicians Resource Council. Ms. Lightfoot holds a Master’s Degree in Psychology and Community Relations, a counseling license and a secondary teaching credential. Dianna’s public service experience includes acting as chief advisor to the Bush White House’s Adolescent Health Initiative, and appointments to serve on the U.S. Department of Justice’s Advisory Council on Domestic Violence; Chair for U.S. Health and Human Services’ National Review Board on Infant Adoption and the U.S. President’s Family Justice Initiative. In addition, she has spoken at numerous international health and education conferences and partnered with Chinese and African government leaders on multiple projects related to health and child welfare. Dianna is passionate about promoting and supporting the principles of limited government, free enterprise and personal responsibility in South Carolina and throughout the nation.

6 Responses to “Health Care Reform’s Mandate Madness”

  1. John R Whiffen, MD February 21, 2012 at 5:09 pm #

    This is an excellent summary of the problems with Obamacare and the Supreme Court challenge. Anyone who is opposed to this legislation should familiarize themselves with the issues raised here and internalize them so they can speak with their friends about this issue.
    While there are many more problems with Obamacare than are presented here, we can get bogged down in the weeds and lose our effectiveness in reaching others.
    Please read this carefully!

  2. Larry wenning February 21, 2012 at 5:42 pm #

    Thank God for people like Dianna Lightfoot who give us the details about this enormous debacle called Obama Care. She clearly explains why it is unconstitutional and why, if passed, it will accelerate our nation into financial collapse and socialism. Anyone who values individual freedom must be bold in opposing an inept, bankrupt, and hopelessly in debt government. President Obama and his administration are determined to make all of us wards of the state. May God not let it happen!

  3. Jane Anderson, M.D. February 21, 2012 at 8:19 pm #

    This article is an excellent summary of the unconstitutional mandates imposed by Obamacare. People in America are generally unaware of the numerous ways our President and Congress have overstepped their authority and Dianna Lightfoot brings attention to some of the more egregious examples. A must read.

  4. AC Wilson February 26, 2012 at 3:19 pm #

    Ms. Lightfoot has exposed a proverbial ‘achilles heel’ of too many Americans and the American culture of today;’ that being a willingness to accept a ‘lie’ in the ’cause’ of TRUTH, rather than embrace the TRUTH which will not accept a ‘lie,’ under any disguise, nor grant moral integrity, for ‘political correctness.’

  5. Dennis Barnes March 28, 2012 at 3:56 pm #

    Regarding the expansion to 133% of the poverty level for Medicare under the healthcare law, the States are claiming precident with the New York decision (1992) whereby the US gave the States a choice to legislate a solution to the storage of radioactive waste, or to take title and become liable to all the waste generators. Justice O’Conner wrote: “A choice between two unconstitutionally coercive regulatory techniques is no choice at all.” The States are claiming that since they are given a choice to either 1) regulate medical assistance for the poor as Congress dictates, or 2) take full responsibility for their own poor and opt-out; that this is identical to the NY case. I think that this precident does not apply since they are not being given a “choice of two evils,” as it were, but rather a take-it-or-leave-it choice. The US is paying most of the cost and States can participate, or not. There is no coercion here.

    • Dianna May 15, 2012 at 7:48 am #

      Mr. Barnes

      Medicaid funding at the state AND federal level comes from the taxpayer’s pocket. Healthcare managed by centralized government has already proven to be ineffective, inefficient and wildly wasteful, bankrupting Medicare, Medicaid and Social Security..not to mention the poorly-perfoming Post Office which loses billions a year. These are examples of the poorest business models immaginable.

      In terms of Medicaid, under Obama Care, new mandates which add enormous burdens to an already overloaded system, will be partially funded for a period of time. Then, the states become responsible for handling many thousands of new participants who will enroll due to the additional Obama Care mandate—the provision forcing individuals to purchase pre-prescribed policies or pay a penalty.

      South Carolina’s Medicaid program already faces a deficit of hundreds of millions of dollars; its sister state North Carolina is in the same position.

      Yes, states can opt out, but Medicaid regulations still apply to existing participants (and in South Carolina, as well as many other states, enrollment is growing by the thousands every month). The federal government’s one-size-fits-all formula cannot work for states so diverse in their populations and needs. Providing for the “general welfare” of the people envisioned by our founders did not include a bloated, Big Brother Centralized Government overseeing something as sensitive as health care.

      How can it be called anything but coercion when Draconian regulations, mandates and penalties are attached to taxpayer-funded programs designed to assist our most vulnerable citizens?

      Federal funds should be block-granted to the states with as little regulation as possible. As governor of Wisconsin, Tommy Thompson proved that would work well with his very successful model project on Welfare Reform (which was duplicated nationwide). The same can happen with Medicaid—if the strings are untied and the free market is allowed to work! We can only hope the Supreme Court agrees.