Getting to the Bottom of ObamaCare Enrollment

From the moment the HeathCare.gov website first launched, people have struggled to understand ObamaCare enrollment.  Most of the confusion stems from the Department of Health and Human Services (HHS) lack of transparency in providing factual enrollment information.

The grand fanfare and jubilation leading up to the unveiling of state and federal healthcare insurance exchanges last October quickly came to an end when the HealthCare.gov website, for all intents and purposes, failed to launch.  And when the first day enrollment numbers trickled in and was learned that only six individuals had sign up for a healthcare insurance, the nation became aware of how very very broken the website really was.

Staff members at HHS were gravely concerned with the technical difficulties the HealthCare.gov website was having but knew that in time they would be overcome.  Their greater concern was with the fact that of the large number who did manage to enter the HealthCare.gov website, only six had enrolled over the first 24 hours.  This had HHS and the entire White House very worried!

The technical issues that plagued the HealthCare.gov website would eventually be ironed out and as the website’s performance improved, it became more and more apparent that attracting new customers would be the greater challenge facing the controversial healthcare law.

Fearing backlash from those who strongly opposed ObamaCare, the game of hide and deceive began.  The numbers game has been so masterfully played by the Obama Administration that to this day it remains uncertain as to exactly how many of America’s uninsured actually obtained healthcare coverage yet most people are under the impression that all the cards have been laid on the table and enrollment met its goals.  Enrollment figures for the 2014 enrollment period do in fact exist however, the administration has made the conscious decision to withhold this information from the American people who are paying for this mess!

Enrollment Goals

Heading in to the 2014 open enrollment period, HHS had set three enrollment goals. 

The most publicized of those goals was the number of uninsured individual projected to purchase a qualified healthcare plan (QHP) from one of the state and federal healthcare exchanges.  In the months leading up to the start of the initial open enrollment period HHS regularly stated the enrollment goal of 7 million, a figure that was adopted from an analysis performed by the Congressional Budget Office (CBO).  It is important to qualify this number as it has been widely misused by the Obama Administration in claiming success during the first open enrollment period, which we will get to later.  For now, what we need to understand about the CBO projection is that it represents only the uninsured nonelderly.

The second and less publicized goal was the percentage of young and healthy, commonly referred to as “the millennials”, projected to purchase a QHP.  HHS anticipated that between 38-40% of all enrollments would come from millennials, a critical goal that had to be met in order to balance the risk between insuring the young and the old.  Under the payment structure put forth by ObamaCare, the young, while costing far less to keep healthy, pay more for their insurance.  This was done to offset the lower cost of insurance provided to the elderly, many of whom are on a fixed income but cost more to keep healthy.    

Last is the goal set for the Medicaid/CHIP expansion which was projected to come in at 8 million by the CBO.

These primary ObamaCare enrollment goals were not just targets the administration wished to achieve, they were goals that were vital to meet so as to ensure the fiscal well-being of the law.  Falling short of any of these goals would have both fiscal and political ramifications as we are now learning.

Ten Million Gained Health Coverage

It took them awhile but four months after the 2014 enrollment closed HHS announced, in a press release , that a new study published by the New England Journal of Medicine ‘estimated’ that 10.3 million uninsured adults gained health coverage during the Marketplace’s first annual open enrollment period. 

The 10.3 million figure, which now has been adopted by the administration, actually originates from a long term study being conducted by Gallup-Healthways Well-Being.  Two other well-known and trusted sources, the Urban Institute and the RAND Corp. have also conducted similar studies which estimate the number to have gained health coverage over the initial enrollment period to be 8.0 million and 9.3 million respectively.

It is important to qualify the figures reported in the above mentioned studies.  In all three cases the studies capture both those who have gained insurance through the purchase of a QHP and those who have taken advantage of the Medicaid expansion and have reported them as one number.  HHS on the other hand tracks QHP and Medicaid/CHIP enrollment separately. 

Here is where the waters get murky.  HHS, having adopted the Gallup findings to portray enrollment success, they do so without qualifying the number thus misleading many in to believing that 10.3 million QHPs have been sold on the exchanges.   Whether the administration does this intentionally or not we will leave for you to decide.

So why does the Gallup study get top billing over the other studies?  The obvious reason would be that their estimates place ObamaCare enrollment in the best light.  A more important question to ask is why HHS does not use its own enrollment count verses and estimate drawn from an independent study?  Chances are the same answer applies!

So for now, we are working with the 10.3 million figure adopted by HHS, we just need to break it down, which we will do in a moment.

Effects of the Medicaid Expansion

On May 1, 2014 the Centers for Medicare and Medicaid Services (CMS) released a factsheet which reported that more than 5.8 million additional individuals enrolled for Medicaid and CHIP during the initial ObamaCare open enrollment period.  This figure is not a reflection of the success or failure of the Medicaid expansion and is only being mentioned as it will be needed in just another moment when we take a closer look at what actually happened with QHPs purchased on the state and federal healthcare exchanges.

By the end of September, 9.1 million had enrolled for Medicaid/CHIP, already exceeding the administrations 2014 goal of 8 million.  It is anticipated that at least 1 million more will enroll for Medicaid/CHIP before the close of 2014, pushing the number of those taking advantage of the Medicaid expansion over 10 million.

Exceeding the Medicaid enrollment expectations is not necessarily good news for taxpayers as the transitional federal assistance will soon be gone and each expansion state will have to make additional budgetary adjustments to accommodate the unexpected higher number of participants. 

Woodworkers, those who were qualified for Medicaid prior to the expansion but did not enroll until the ObamaCare rollout, have also exceeded predictions and will too need to be accommodated for in states budgets. 

Enrollment Confusion on the Exchanges

If you like your plan you do not necessarily get to keep your plan was the lesson millions learned as we heading in to the fist open enrollment period.   And while a political battle raged around a near mortally wounded HealthCare.gov website, more and more of those who had their insurance policies canceled began to purchase new policies via a website that was being held together with bailing wire and duct tape.

At the halfway point, HHS reported that an estimated 2 million had signed up for a QHP, leaving a lot of ground to cover in order to reach their 7 million target.  However, as the inaugural sign up period approached the finish line, enrollment improved significantly and at the closing bell looked to have reached just over 8 million.  The speculation is that cancelations were becoming affective and drove a swarm of those affected to the exchanges.

With ObamaCare proponents celebrating their faux success, the opposition was crying foul as, by all indications, a very large percentage of the QHPs sold on the exchanges were purchased by those who had their policies canceled.  Skeptics also called in to question the number of the claimed 8 million enrollees that had actually finalized their transaction by providing payment to the insurer.

As it turns out, at least 1 million who selected a QHP on one of the exchanges ended up not paying for their plan.  Adding insult to enrollment injury, congressional oversight recently discovered that HHS had counted some 400,000 dental only plans as complete enrollments.  This prompted HHS to revise down their enrollment figure, for the fourth time, to 6.7 million.   

Policies Were Canceled

It is hard to put a finger on exactly how many policies were canceled for not being ACA complaint but the number is well into the millions. 

The Urban Institute, a Washington DC-based left leaning think tank, puts the number of canceled policies to be as low as 2.6 million.  On the other side of the spectrum, the Rand Corp, a left to center global policy think tank speculates that cancelations could be as high as 4.7 million.  And these are policies, not individuals these studies are speaking of so the number of individuals who lost coverage through cancelation could be staggering.

It is hard to fathom that HHS does not have a good estimate as to how many individuals were affected by the cancelations just as it is hard to imagine they also do not know how many QHPs were purchased by them.  If they do in fact know, they are being very tight lipped about it.

How Many Long Term Uninsured Actually Purchase a QHP?

The Obama Administration has been deliberate in its intentions to withhold enrollment figures, likely in an effort to prevent the political firestorm that would ensue by an admission of failure.  But HHS has laid claim to enough pieces of the enrollment puzzle that a reasonable picture can be painted.

If you were to take away the 5.8 million Medicaid enrollees from the 10.3 million reduction of the uninsured, the figure adopted by HHS, you would arrive at 4.5 of the 6.7 million QHPs purchased during the open enrollment period belonging to the formerly uninsured.  Possible sure, but unlikely as this leaves only 2.2 million enrollments transpiring from the 2.6 to 4.7 million canceled policies.

A more believable scenario would be to use the Urban Institute’s 8 million estimate in the reduction of the uninsured.  Doing so, you would arrive at 2.2 million QHPs purchased by the formerly uninsured once the 5.8 million Medicaid expansion enrollees are backed out.  This better accounts for the number of those who lost their healthcare plan and subsequently purchased a QHP from one of the exchanges but speaks very poorly of ObamaCare’s ability to attract the uninsured.   

Without actual figures provided by HHS, these educated speculations are as good as it gets.  Neither plays well as a measure of success for the ObamaCare law and yet, the administration has done nothing in helping us to draw a better conclusion.

In Conclusion

If it remains the goal of the Obama Administration to convince 25 million uninsured nonelderly to purchase a qualified healthcare plan by 2017, we can go ahead and call the game now.  As it stands, fewer than 10 million in the target group are likely purchase a QHP by 2017 leaving 39 million remaining uninsured and this is being optimistic. 

There appears to be little interest on the part of the uninsured to purchase healthcare insurance even under federal mandate.  Reasons for this could be complex or maybe as simple a misguided belief that the product is so good that people would be fighting to sign up.

Whatever the case, no amount of touting misleading numbers and overstating the success of the unpopular healthcare law will be able to save ObamaCare in the end.  With a price tag well in excess of $2 trillion over the next decade, those footing the bill are going to demand that the healthcare law deliver as promised or will call for its repeal.

Republicans Have Just Gotten Started On Immigration Reform

President Obama’s Imperial Action, he discussed in his 12 minute address on immigration last night, will have little if any effect on Speaker Boehner’s plan on how the House will move forward on immigration reform in the coming months. 

In a desperate attempt to remain relevant, the lame duck president has made things worse for both himself and the Democratic Party by attempting to bully what will be a fully republican controlled congress come January.  Republicans are just getting started on immigration reform and there is nothing President Obama can do to change that.

We have all heard the talking points; democrats failed to move on immigration reform when they controlled congress, Obama failed to make immigration a priority until after the 2012 election and now, with a Senate bill passed, the House refuses to “act responsibly”, in the words of the president, and take the bill to the floor for a vote.  This political rhetoric is just a temporary distraction from the problem the democrats face on immigration.

Speaker Boehner was more than forthcoming with his announcement earlier this year when he indicated that there was a faction in the House, including himself, that simply does not trust the president to enforce the laws of the land and rightly so!  Boehner also has stated that until this situation changes, it is unlikely that the immigration debate will move forward. 

Well that change took place earlier this month and Republican are poised and ready to move forward on immigration reform once the new Senate is in place in January.

This is about Border Security not Deportation

The entire immigration stalemate revolves around the failure to secure our borders.

Republican lawmakers have no more intention of rounding up and deporting the estimated 11.5 million illegal immigrants living in this country than do the democrats, but insinuating so makes a great talking point for the left.

Our immigration system is broken and has been for decades as was stated by Senate Majority Leader Harry Reid in a recent interview with Univision.  In an attempt to justify the forthcoming executive action to be taken by the president on immigration, Reid stated,

“Republican presidents going back to Dwight Eisenhower have used executive action to fix immigration,” 

While it was Reid’s intention to make the point that republican presidents have repeatedly used executive action to grant amnesty to illegal immigrants, just as President Obama was preparing to do, he instead admitted that for the past half century both republicans and democrats have failed to stop the inflow of illegal immigrants into this country.

The Senate Immigration Bill is Flawed

The 1300 page Senate immigration bill that President Obama has been pushing Boehner to allow a vote on in the House is no exception to the long list of legislation that have failed to adequately address the issue of border security.

The Senate bill does a great deal in the way of granting amnesty to those who have entered this country illegally and very little to ensure that the inflow of illegal immigrants is stopped.  The Senate immigration bill will do little more than ensure the cycle of unlawful entry to amnesty that has plagued this nation for decades continues.

In particular, there are two non-starters in the Senate bill for House Republicans.

The first is that the Senate bill places legalization ahead of security.  The majority of House Republicans have been adamant that the borders must be secured before handing out legal status to those that are already here.  Failing to reform immigration in that order is only asking for more immigrants to cross over the boarder while the border security issue continues to get hung up in congress and the courts.  Republican lawmakers have made the offer, time and again, to put forth legislation that first secures the border and then works towards amnesty but those offers have been rejected by democrats without debate.

The second non-started is that the bill simply does not stop the inflow if illegal immigrants.  According to an analysis conducted by the non-partisan Congressional Budget Office, the Senate immigration bill will reduce illegal immigration by only one-third to one-half and this prediction is made on the assumption that the president will actually enforce the law and not make unilaterally changes to it that would weaken boarder security.

The House also has a constitutional concern with the Senate bill which contains some revenue-raising components.  Per the United States Constitution, all revenue bills must originate in the House.

Democrats Have No Interest in Securing the Boarder

If history is any indicator, the likelihood of democrats living up to any of the border security measures proposed on the Senate immigration bill is slim to none.

Republicans got duped in the 1986 immigration overhaul were 3 million undocumented immigrants were granted the opportunity to apply for citizenship in exchange for a secure border.  Ronald Reagan held up his end of the bargain but democrats reneged on theirs and the border was never secured.

The same thing happened when George W Bush signed the Secure Fence Act into law in 2007, a law that received tremendous bi-partisan support.  And yet, the following year, with then House Majority Leader Nancy Pelosi at the helm, funding for the act was slashed by House appropriations, an action that is most certainly being reminisced by House Republicans after last night’s promise of executive action on immigration by the president.

And it was just this past June that Nancy Pelosi described the United States as a “community, with a border going through it” and added, “We are all Americans – north and south in the hemisphere.”

It’s pretty hard to imagine that, with the democrat’s track record, they would stand by any border security components legislated in the Senate immigration bill thus giving no reason for Boehner to take up the bill.  Fool me once, shame on you, fool me three and four times, I’m just a lousy legislator.   

This Is On Obama

The sentiment of House Republicans is both real and justified.   The precedent of President Obama to assert his executive authority and override laws has been demonstration well over a dozen times on the ObamaCare law alone, not to mention executive actions he has already taken on other immigration matters some of which resulted in a huge inflow if illegal immigrants.

At the bidding of President Obama, the Senate immigration bill is another fine example of political game play.  A bill well-crafted to foster strong bi-partisan support in the areas of amnesty but loosely structured when it comes to the creation and enforcement of border security.  And with no intention of compromise on the border security issue, the president and his party have made it easy to portray House Republicans as wanting to deport millions of illegal immigrants.

But the plan has backfired on the President as he lost his trump card, his party’s control of the Senate.

House and Senate Republicans most certainly will be working together to bring a piece or maybe even a number of pieces of legislation to their floors for passage and then on to the President’s desk.  The legislation is likely to closely resemble the existing Senate immigration bill in regards to the handling of the millions of illegal immigrants that are already in this country leaving the president little excuse not to sign that piece of legislation into law.  There will also be a piece of legislation that demands border security before any form of path to citizenship can commence.  The failure of the president to sign this piece of legislation in to law will clearly show that he has never had any intention to close our borders.

House Republicans have the voice of the people on their side, the majority of which are in lock step agreement with their approach to immigration reform. 

President Obama will have to make a choice.  He can compromise on the issue of border security or he can veto the Republican bill(s) and take additional executive action to grant amnesty to millions of illegal immigrants already here as well as keep the flow illegal immigrants into our country alive.  If he chooses the latter he will then have to pray his actions survive legal challenge.

Let Us Not Forget the Constitution

All the immigration debates and legal wrangling that is set to take place in both chambers of congress is pillow talk compared to the constitutional challenge that will be set in motion when the president oversteps his constitutional authority with the executive order he is getting ready to sign.  President Obama is not a legislator; he is the executive and therefor has no constitutional authority to change the law as he has so stated he is going to do. 

This is not an issue up for debate, it is implicit and intentional in the United States Constitution as our founding fathers had the fortitude to see the dangers of allowing the powers of one branch of government to reach into another.

Jon Gruber - A Beacon of Modern Progressivism

Jon Gruber may not be the death of ObamaCare, as many of the law’s critics would like him to be, but he has most certainly become the poster child for all things that are wrong with Modern Progressivism.

Jon Gruber was a name largely unknown to the average American until recently, when a story  broke of his involvement in the orchestration of ObamaCare in which he stated that it was “the stupidity of the American voter” that lead to the passage of healthcare law.

When you watch the numerous video clips that have surfaced of Gruber, if his display of arrogance does not make you want to pull him through the computer monitor and punch him in the face, the smug and caviler manner to which he speaks down on voting Americans certainly will.  Of course there are those that share the progressive view that “people are not smart enough to think for themselves” who probably applauded Gruber when the watched these videos.

Sadly, Gruber does not have a corner on the market of his own special kind of ignorance as his general attitude towards the average American is not much different from many other modern progressives including our very own President Obama.  There will be no better example of the “I know better what is good for you” mentality that envelopes modern progressivism than will be demonstrated tonight when the president addresses the nation and spells out his plan to halt the deportation of 5 million illegal immigrants through executive fiat, a move that has and continues to be strongly opposed by the vast majority of Americans.

In a recent appearance on Fox News The O’Reilly Factor, Charles Krauthammer summed things up perfectly when speaking on the topic of the Gruber videos with host Bill O’Reilly:

“This is exactly what conservatives have been saying for four years. What we’re hearing now is the true voice of liberal arrogance. [T]hey believe they know the right way—they have to lead the masses to the Promised Land, and they can only do it by deception. And that’s what he said openly…[they] lied about everything.”

It is not the progressive’s desire to move towards better conditions in society and government that is flawed, it is the arrogance that has been adopted in the approach to reach this goal that is wrong.  We are seeing it more and more, this attitude of “the end justifies the means at any cost”, coming from modern progressives and even more terrifying, many have grown so arrogant that they are stating it openly.

Our own US Attorney General Eric Holder, another pillar of progressivism, shared with us in a New York Times interview this past February how progressive ideology trumps the rule of law that governs our nation, or at least used to.  Speaking on the topic of gay marriage, in his interview he stated that state attorney generals do not have to enforce laws they disagree with, specifically when it comes to the issue of gay marriage. 

It does not take a Harvard Law Professor to see how dangerously wrong Eric Holder was in telling states attorney generals that they do not have to enforce laws that they do not agree with, unless of course you share the same “I know better therefor laws I do not agree with do not apply to me” progressive view that America’s top cops does.

There is no defense for Holders suggestion to act lawlessly, but in his mind he did so in support of what he truly believed to be right which, as dangerously flawed as his logic may be, at least he did not do so out of malice. 

On the other hand you have Jon Gruber, a hired gun and political mercenary of sorts who acts at the bidding of whoever is signing his paycheck.  And it is his progressive ideology that creates the arrogance used to justify the manipulation of the means in any way necessary to reach the end.  The particular skillset to manipulate the truth into a more attractive narrative, that Jon Gruber possesses, has been highly coveted by the Obama Administration and other states political proponents of ObamaCare.

Jon Gruber is certainly not alone in his arrogance, but recent events have most defiantly made him America’s poster child for all things wrong with Modern Progressivism.

The Harsh Reality of ObamaCare

It seems as though most people who support ObamaCare are oblivious as to the reasons why the majority of American’s oppose the law.  Nobody that opposes ObamaCare denies the fact that the law has in fact provided healthcare to a large number of Americans who could not or, in many cases, chose not to afford healthcare insurance.  As well, they do not deny that ObamaCare has provided for the vital need of healthcare insurance to those with pre-existing or bank account breaking health issues who have, in the past, been denied insurance.  These are certainly not the reasons that the majority of Americans oppose ObamaCare although they have been made out to be so by the liberal media and the president himself.

The reality of ObamaCare is that it overly burdens the vast majority of American’s.  There is no denying that before ObamaCare, taxpayers were already picking up the healthcare tab created by the uninsured, a problem that has been in need of repair for decades however, ObamaCare does not address the real issues of cost, it simply makes the problem worse.  In addition, the progressive law passes an incredible amount of inequality on to those that carry the burden.

In an effort to provide what President Obama once commonly referred to as “Affordable HealthCare for All”, instead what has been delivered is a not so affordable healthcare mandate that has been rejected by the uninsured.  In addition, under the regulations put forth by the overly intrusive law, highly subsidized healthcare insurance, provided to many who once had none, often exceeds the quality of insurance many who have historically remain insured were once able to afford themselves. 

Now having to pick up the brunt of the cost burden, a healthy, middle class, middle aged wage earner has, in far too many cases, had to sacrifice the level of healthcare coverage they could once afford in order to keep their premiums within their budget.

What Happened to the Individual Marketplace

To offset the cost of the mandates ObamaCare places on individual insurance coverage, rates on the individual insurance marketplace have increased across the board and have been doing so since just after ObamaCare was passed in to law back in 2010.  Additionally, insurers have had to drop many of the plans they once offered due to the restrictions and mandates imposed by the law.  Insurers have either found certain plans to be non-compliant or no longer cost effective to maintain.  By eliminating these plans they have also removed much of the choice from those that have historically paid for their own healthcare insurance. 

What many have long believed might happen to the individual marketplace is no longer speculation, it is happening now.  Higher rates and fewer choices are a fact of life under the constraints of ObamaCare.  The subsidies and entitlements have to be paid for somehow and by somehow I mean by resting the burden on the shoulders of the middle class!

Affordability is not reformed into healthcare by ObamaCare, instead it is forced into the healthcare plans of those that meet a certain domestic and fiscal criteria.  A large portion of the funding stream for this progressive form of affordability is created through a wide array of taxes and fees on health and medical related industries, the burden of which is simply passed on to the consumer.

ObamaCare is Disliked by Consumers

Maybe the harshest reality ObamaCare must face is its rejection by the consumer.  Only 3 million formerly uninsured individuals chose to participate in the federal mandate by purchasing healthcare insurance on one of the state or federal healthcare exchanges during the six month, 2014 open enrollment period.  For years leading up to and right to the launching of the HealthCare.gov website, those involved in the selling of ObamaCare regularly touted high turnout expectations yet when the dust settled, enrollment of uninsured America’s fell a full 4 million short of the target set by the Obama Administration. 

And the Obama Administration has recognized the laws rejection by the consumer as it recently lowered significantly its enrollment expectations for 2015.

The Obama Administration originally expected 6 million individuals to be added to the list of formerly uninsured, during the 2015 open enrollment period, which is currently under way.  However, in lieu of the laws unpopularity, the administration lowered its enrollment expectations by 3 times, to a mere 2 million.

Insurers Face a Harsh Reality Also

For insurers, the harsh reality of ObamaCare is no better than what consumers encountered as the law is likely to face a full repeal assuming it does not implode into itself first.

For now, those insurers who have agreed to participate on the healthcare exchanges are shielded from loss until 2017 through a provision built in to the law which provides them fiscal assurances during a three year transition period.  The transition period was demanded by and granted to the insurers for talking on the risk while the marketplace takes time to stabilize and they gain enrollment. 

The big payout for insurers to participate on the healthcare insurance exchanges comes from the claim made by the Obama Administration that 25 million of America’s uninsured would add themselves to the individual market place by 2016.  25 million new customers creates a great incentive for insurers to compete for this added business but the low premiums, which are key to attracting the uninsured, have proven difficult to produce.  Instead of making healthcare insurance more affordable, a laundry list of essential benefits mandated to be included in every insurance package, has driven costs up thus making the healthcare insurance too costly for the majority of the uninsured even when they qualify for subsidies.

Insurers cannot be pleased with the low enrollment turnout of 2014 nor can they be happy with the low expectation the Obama Administration has for the 2015 open enrollment period.  As it looks now, enrollment will be 5 times short of the original goal heading into the 2016 enrollment period this time next year.

And we have to assume that for now, while being provided loss protection by the taxpayer, insurers are holding premiums down as low as possible, likely at the request of the Obama Administration.  Losing their protection from financial losses come 2017, it is expected that premiums will rise.  This is as concerning to the insurers as it is to the consumer as higher premiums will drive many of their customers back to the rolls of America’s uninsured.

You can bet your bottom dollar that insurers are watching close, crunching the numbers and assessing their risk on a regular basis.  Once their risk becomes too high, rest assured, they will end their participation on the healthcare exchanges.  When one insurer leaves it will not be long before others follow and eventually there will not be enough insurers participating on the healthcare exchanges to adequately cover consumers and ObamaCare will crumble.

Working with Congress - The Success of Presidents both Past and Present

The morning after the sweeping republican mid-term victory, President Obama offered his congratulations to the new Republican Senate.  Now, two weeks later, the president has set the stage for a congressional showdown between himself and republican lawmakers.  

Immediately following the mid-term elections, President Obama began to make demands on the lame duck congress to put a piece of immigration reform legislation before him or he would act on his own.  The president has had six years to push congress to move immigration reform forward, two of which his party had full control of congress and could have pushed just about anything through they wished, just as they did with ObamaCare, and yet he did nothing.  Instead the president has chosen the lame duck session to demand action from congress OR ELSE!

This is just another fine example of the kind of failed leadership that is routinely displayed by President Obama who continues to place the blame of his go nowhere agenda on the inactions of congress.  But blaming congress carries no water as a countless number of his predecessors managed to get a great deal of work accomplished while working with a mixed bag of congressional make-ups.

Past Presidents and their Congress

Take Richard Nixon for example!  Despite his many flaws, Nixon was able to work with his democratic congress.  Had their working relationship been better, Nixon would have been more successful with is domestic policy agenda but congress did little to object to his foreign policy which was quite successful.  Nixon’s demise was not one of contention between him and his democrat controlled congress, his demise was of his own making.

It is hard to fairly assess any aspect of the Ford presidency as it came under such a peculiar circumstance and all would be pure speculation.

Jimmy Carter had a contentious relationship with congress but with the democratic faction, not the republicans.  Carter, trying to do what he believed to be the right thing for the country, almost always came in conflict with the views of the very liberal congress of the time.  Carter didn’t “play ball” with his congress who essentially made a lame duck president out of their party leader, but at least Carter tried.

Ronald Reagan enjoyed a very good relationship with congress throughout his 2 terms as president.  While republicans did hold the Senate for Reagan’s first 6 years in office they never held the House.  But despite never having full control of congress, Reagan’s conservative policies and leadership style seem to bode well with the democrats of his time and made for a very productive, successful and fulfilling 8 years for both the president and the congress.

Bush Senior was a single term president which typically indicates that the president did not share a good relationship with his own party and to some extent this was true.  During his term in office republicans did not carry the Senate or the House although this was really not the issue.  Bush 41 ran on a platform that promised a similar administration that of his predecessor Ronald Reagan, the idea being that he would continue with the successes of the previous 8 years and not make any radical changes.   It sounded like a good plan but something had to be done with the mounting deficit created during the Reagan years. 

Having already made the infamous promise of “Read My Lips, No New Taxes”, Bush 41 lost his own parties support when in the end he had to concede to democratic pressure which blocked his desire to impose tax cuts as a solution in lieu of the typical tax hikes favored by democrats.  It was not due to a bad working relationship with congress that caused Bush 41 his problems it was the breaking of a single promise, that voting republican’s held him to, that cost him a second term in office.

Bill Clinton, much like President Obama, had the luxury of a democratic controlled congress his first two years in office however, failed to capitalize on it.  After democrats lost both the House and Senate in the mid-terms, things became quite contentious between the president and the republican held congress.  But Clinton remained popular and after being re-elected did a bit of a reset and as his relationship with congress improved significantly as did his ability to move parts of his agenda forward.  Even through all the missteps and scandals that surrounded much of Clinton’s second term, a great deal was accomplished or at least that is the opinion of many.  No matter, on the subject of the president’s ability to get legislation moved through congress, Clinton seemed to manage well in an environment where most would have predicted him to have failed.

Overall, George W Bush shared a reasonable relationship with congress.  During his first two years in office the congress was split with the Senate belonging to the democrats and the House held by republicans.  Wanting to set a tone of bi-partisanship, Bush 43 avoided conflict with congress as much as he could and during those first years he never handed out a single veto, in fact, it was not until about 2 years into the full republican controlled congress that Bush exercised his veto power for the very first time. 

Bush 43 enjoyed the comfort of a republican controlled congress during the middle 4 years of his two terms in office however, his relationship soured during his final two years when democrats took over the House.  Looking ahead to 2007 democrats chose to politicized the Iraq war, a war they almost unanimously supported in the onset, an action (it was never declared a war, big mistake by Bush) that received full congressional approval and a war that in the end democrats turned into a political opportunity to demonize the Bush presidency in an effort to score political points heading into the next election cycle.  It was a hypocritical but effective move by democrats which turned public sentiment away from the original intent of the Iraq war and the fact the democrats were for it before they were against it.  None the less, Bush 43 worked well with his congress through all but the very end of his presidency.

That makes a half dozen of the most recent presidents all of which seemed to manage well with congress in most cases. 

So how does President Obama stack up to the leadership of his predecessors?  Let’s take a look.

President Obama and his Congress

Then Senator Barack Obama not only campaign on a platform of Hope and Change for the nation, he also vowed that he would restore the people’s faith in their government and remove its dysfunction.  In a 2007 campaign speech Obama said that he would "turn the page on the ugly partisanship in Washington and pass a bipartisan agenda in Congress.”  Obama also wrote, in his Blueprint for Change, that his administration would increase transparency so that ordinary Americans can understand their government and trust that their money is well spent and also that his administration would end the practice of writing legislation behind closed doors.  Whether or not he had good intention when he spoke/wrote these words we will never know but his campaign vow of transparency and a united congress evaporated about a minute after sitting down in his new office for the first time.

While they may not have fully agreed with the particular path the newly seated president chose, republican lawmakers wishing to work with Obama and the democratic controlled congress, in large, gave their support to the president’s early plans to move the economy forward.  And with his massive spending package signed, sealed and delivered with the consent of congress, Obama cleared his desk and set his sights on healthcare reform!

The relationship between the president and republican lawmakers went downhill rapidly from this point forward.  What was later realized as little more than political showmanship, the bi-partisan effort to craft a healthcare reform bill was soon taken behind closed doors with a ‘Democrats Only’ sign hanging from them.  The fight between the parties grew contentious as republicans liked less and less what they were learning about the partisan healthcare bill being drafted.  And the contentiousness spilled over to other agenda items as the president became highly defensive of anyone who challenged any portion of his progressive agenda.

The dam broke when, through the less than ethical actions of Harry Reid, the Patient Protection Affordable Care Act bill, better known as ObamaCare, was moved forward by both the House and the Senate with ZERO republican support and exactly enough democratic votes to pass the bill to the president to be signed into law.  ObamaCare was not the only point of contention between democrats and republicans early in Obama’s term as president but it was the issue that cost democrats their majority in the house in 2010.

President Obama having failed to take advantage of his party’s monopoly on congress during his first two years in office and the loss of democratic control of the House left him with a stack of unfinished business.  The big ticket agenda items, of the president’s, were all far too far to the left to foster any support from house republicans at least not without some compromise, especially after demonized them almost non-stop from the start of his presidency.

Fast forward to 2014, as the president continued to swim in the pool of his own arrogance, the thought never crossed his mind that democrats could lose control of the Senate.  Now having done so, the president finds himself ill prepared to deal with the very republicans he has for the past four years blamed for all the inactions of congress.

Having lost the cover of Harry Reid and not wanting to compromise on an immigration reform deal with republicans, President Obama has decided that he will use his executive pen to circumvent congress and take whatever unilateral actions are available to him and glue together some type of makeshift immigration reform using a number of executive orders. This action, if carried out, will set a very negative tone for the remaining two years left in his presidency, adding to the dysfunction that has existed between the legislative and executive branches during his term and will likely wash away any hope of democrats remaining in control of the White House come 2016.

Americans Have Opposed National Health Care for Over 150 Years

The first federal healthcare proposal dates back to 1854 when congress passed a bill that would fund asylums for the insane.  The bill was vetoed by President Franklin Peirce as he felt it was not the federal government’s place to engage itself in social welfare.

In 1912 Theodore Roosevelt, campaigned to establish national health insurance system modeled after the German program.  The idea of national health insurance never grew legs and by the time the great depression rolled around, the idea simply became unaffordable.

The next attempt at national healthcare came in 1935 when President Franklin Roosevelt attempted to include compulsory healthcare insurance along with social security.  Pushback from the American Medical Association, who strongly opposed any government run healthcare system, caused Roosevelt to abandon the healthcare aspect of his plan and to stay focused on social security.

In the early 1940’s, in an effort to attract workers, many businesses began to offer different benefits including private health care thus making healthcare a common “benefit”.

President Truman took a swing at national healthcare in 1945 but it was again denounced by the American Medical Association as being socialized medicine and never made it through congress.

During the Kennedy presidency, the president tried to create a federal health care entitlement program for the elderly but was unsuccessful in doing so.  It was not until President Johnson’s term in office that this goal was finally achieved by the adoption of two of the largest federal entitlement programs into law, Medicare and Medicaid.  The fiscal ramifications of healthcare entitlements were immediate and highly unpopular.

President Nixon pushed for a mandate that would require all employers to provide healthcare insurance to their employees.  Nixon also wanted to create subsidize so that individuals could purchase healthcare insurance on the private market place however, President Nixon got caught up in a little scandal that took his attention away from healthcare.  At the same time Senator Ted Kennedy began what would become a lifelong push for a single payer universal healthcare plan.

When President Ford arrived in office, the economy was in steep decline and inflation on the rise.  The President did not have the stomach for new government spending in the midst of economic woes and vowed to veto any healthcare bill that crossed his desk.

Just a few years later it was President Carter’s turn to take a stab at national healthcare but due to the condition of the economy, Republican’s wanted no part of a new federalized entitlement.

Then in 1988 President Regan passed the bi-partisan Medicare Catastrophic Coverage Act (MCCA) only to have it repealed a year and a half later.  The parties over-extended themselves and tried to do too much too quick and those paying for the MCCA revolted.

In 1993 Bill Clinton took his shot at instituting a national healthcare system with a little thing they called HillaryCare.  HillaryCare was very far reaching and came under opposition from both republicans as well as from inside the Democratic Party.

A few years later in 1997, Clinton had given up on HillaryCare but had great success with the State Children’s Health Insurance Program (SCHIP or CHIP) which filled an important gap between families whose income was modest but too high to qualify for Medicaid.  CHIP was passed with bi-partisan support.

In 2003 the Bush administration put forth the largest expansion to healthcare entitlement since 1965 with Medicare Part D.  Meeting significant opposition from liberal democrats who essentially said that republicans were unable to put fourth any degree of successful reform, the bill eventually gained bi-partisan support and was passed into law.

Fast forward to Hillary Clinton’s run for the Democratic Party nomination.  HillaryCare was again introduced and was a key part of her platform.  Hillary lost the nomination to then Senator Obama in part due to her aggressive plan for healthcare reform as oppose to Senator Obama’s seemingly milder stance on healthcare reform (at the time).

This brings us to the election of President Obama which came with sweeping changes to the nation’s healthcare insurance system under what would come to be known as ObamaCare.

Heavy mandates were placed on both individuals and employers to have and provide healthcare insurance or pay a fine (tax).  There are a number of highly controversial elements in the law, many of which President Obama opposed of himself during his run against Hillary Clinton however, changes to the healthcare plan were necessary to ensure a clean vote and to avoid filibuster. 

President Obama’s push to fundamentally change the nation’s healthcare system came at a time when the nation was in its deepest recession since the Great Depression and is littered with numerous new taxes and revenue streams to pay for its massive price tag.  Passed on a 100% partisan vote, ObamaCare has been met with strong opposition from the small business owners, republican law makers and the majority of the American people.

Changing the Talking Point on Lower Premiums

For nearly two years preceding the rollout of the HealthCare.gov website we heard, time and again, the president and his parties political pundits speak of how ObamaCare was going to bring greater competition to the individual marketplace, how ObamaCare was going to put $2500 back into the pockets of American families and the tallest tale of them all, that ObamaCare was going to bring lower premiums thus making healthcare insurance affordable to virtually everyone.  But as rate information began to surface, headed in to the first open enrollment period, it became painfully clear that the administration’s claims of lower premiums were not coming to fruition.

With the news of higher premiums heading our way, the stories of cost savings greatness subsided and the Obama Administration went into full damage control mode.  Across the news networks and social media, those in support of the Affordable Care Act were working overtime to squash the stories of skyrocketing premiums that were developing.  It was a daunting task with no defense but like good party soldiers, they persisted.

New York Became Obama’s Poster Child

The only bright light to the repeated claims of lower premiums was the State of New York.

Back in the 1990’s then New York Governor Mario Cuomo put forth a series of reforms aimed to lower the number of the uninsured in his state.  The reform measures were a debacle and drove insurance rates in the state to the highest in the nation.  Of course skyrocketing rates meant that more New Yorkers would become uninsured, driving the state’s insurance industry into a death spiral of which they never recovered from.

Fast forward to2013 and the months heading into the rollout of the HealthCare.gov website.  It was at this time that news began to trickle in from leading industry sources and insurers themselves which started to paint the picture of how healthcare premiums were shaping up across the country.  The news was not following the administrations talking point of lower insurance premiums with one exception, the State of New York!  The new rate structure brought forth by ObamaCare was, for this single state, a vast improvement over their very broke healthcare insurance system.

And so, on the eve of the inaugural HealthCare.gov rollout,  New York’s Governor Andrew Cuomo announced to New Yorkers that those seeking healthcare insurance would find rate reductions as much as 50% once the states healthcare exchange opened for business in the coming hours. 

New York was one of only three or four states that realized a reduction in healthcare insurance premiums under the new regulations put forth by ObamaCare and the only state where the reductions were substantial.  With insurance rate increases of 40% on average being realized in virtually every other state across the country, it did not take long for the news media to fill the headlines with stories of double digit premium increase.

Yet despite the fact that only one of fifty states and DC delivered on the promise that premium would be lower, immediately following New Yorks Governor Andrew Cuomo’s announcement, President Obama stood before a national audience and claimed a victory for ObamaCare making New York his lower premium poster child.  In his victory speak, the president did not find it necessary to disclose that New York was an isolated case nor did the president find it necessary to mention that most of the nation would be seeing double digit rate increases.

The Talking Point Changes

The disastrous rollout of the HealthCare.gov website turned the attention away from skyrocketing healthcare premiums just long enough for the Obama Administration to come up with a new battle plan.

Needing to continue with the years long promise that ObamaCare would lower healthcare premium, a new qualifier was added to the talking point.  Never before tied to the claim of lower premiums, the Obama Administration was now and would forever add the small caveat of “with subsidies” whenever making the claim the ObamaCare has lowered premiums. 

Taxpayer funded subsidies where always a major selling point of ObamaCare however, not until it was revealed that premiums increased almost universally did they become part of the talking point.  President Obama had for years proclaimed that ObamaCare would drive healthcare insurance premiums down, never attaching subsides to the claim.  Until this point, subsidies had always been touted as a benefit that would drive additional affordability into the cost of healthcare, not be the mechanism which created the affordability.  As it turned out, even with subsidies, a significant percentage of individuals who purchased a qualified healthcare plan still ended up paying higher premiums.

A New Era of HealthCare Insurance

As a result of intense negotiations between the president and insurers, to hold premiums down, we arrived at the second round of ObamaCare enrollment to find significant changes to many healthcare plans.  Some plans offered during the initial open enrollment period have been canceled while others have had rate structure changes. 

Health and Human Services (HHS) Secretary Sylvia Burwell earlier stated that rate stability in the marketplace is not expected to come for several years as insurers look for ways to attract new customer as well as to retain their existing customer base.

Lower premiums and affordability are no longer the talking points of ObamaCare.  Instead, both HHS and the president himself have gone on a campaign urging people to “shop for the best deal”. 

And what exactly does “best deal” mean?  For most consumers it means that they will be seeking out an insurance plan that provides a lower premium to offset the rate increase they have incurred.  It is a tradeoff however, as with lower premiums almost always comes higher deductibles, higher co-pays and fewer options, all tools that insurers must use to balance their costs.  We mustn’t lose sight of the fact that ObamaCare did not reform healthcare costs, it merely imposed massive regulations therefore making it impossible for insurers to lower the cost of one component of a healthcare plan without raising the cost of another.

So, for the foreseeable future anyway, annual shopping for the best healthcare insurance deal will likely be the new norm.  If this is the case then gone are the days of establishing long term relationships with your doctor and for many, it may mean longer trips to visit a doctor when affordable healthcare cannot be found locally.