- - Monday, May 25, 2015

Obamacare seems about to implode, and the implosion could be a great contribution to those who would reform America’s health system in a systematic way. The nation will have to get it right the second time around.

Hawaii’s exchange is the latest of the 13 states to hit the wall with a state-run exchange to dispense medical insurance. That’s despite taking $205 million in federal funding to set it up and keep it standing, part of the $4.5 billion federal effort to save the exchanges. Only 37,000 customers enrolled in Hawaii’s exchange — far fewer than the 70,000 needed to make it work. The Hawaii legislature refused to contribute another $28 million after not a single person signed up during the extended enrollment period. The exchange has closed down from time to time to fix problems with its website.

Hawaii’s dilemma is only part of the national dilemma. Next month, the U.S. Supreme Court is expected to say whether Congress, in enacting Obamacare, intended for the federal subsidy to be paid to individuals insured by state exchanges, or to limit the subsidy to insurance bought through federal exchanges. Opponents of Obamacare argue that since the law plainly restricts the subsidy, the law must be honored. The Obama administration argues that the drafters simply made a mistake in drafting the law and the mistake should be ignored and the law interpreted to mean what the administration wants it to mean.

It’s a tough call for the court. “Legislative history,” the record of the debate that produced the law, could reveal what was in the minds of the drafters. But since Obamacare was rushed through by Democrats then prevailing, that intent is not clear. Nancy Pelosi, the speaker of the House at that time, said no one would know what was in Obamacare until the law was enacted. How right she was. These are the details where only the devil thrives.

The days when the “Bourbon-and-branch water” veterans, with long and valuable experience in drafting legislation, presided over Congress are long gone. They have been largely replaced by “blow-dry boys and girls,” highly credentialed but often driven more by partisan allegiance than a hard determination to get things right.

If the Supreme Court rules for the administration, the troubles with Obamacare might be only beginning. The states that did not set up exchanges would be encouraged to do so to get the federal subsidies. But the federal government is running out of money for that; it doesn’t even have the money now to set up the websites.

President Obama insisted on reforming the health care system his way, and the Democrats fell meekly in line. They were warned that Obamacare wouldn’t work. They didn’t listen, and now everyone must pay.

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