A Conservative Alternative to Obamacare

The problems with the law are well documented; now is time for a solution.

by Prof. Patrick Garry:

The conservative opposition to Obamacare is well documented, as are the problems with the law and the unpopularity of it.  With each passing day, the American public becomes increasingly aware of the costs and burdens of the Affordable Care Act.

ObamacareAmerica’s health care system was riddled with problems long before Barack Obama became president.  But Obamacare only made things worse.  So now that Republicans control both houses of Congress, and with the 2016 presidential campaign about to begin, it is up to conservatives to offer a better solution.

Instead of having the federal government mandate health care directives to a vast and diverse nation, an efficient system would have individual consumers play a more active role in their health care.  Because who better to make decisions about health care than the person whose health is at issue?  A competitive consumer market is the only known means of lowering costs while increasing supply.  The problem is: Obamacare went in the opposite direction.

The problems and betrayals of Obamacare give conservatives a chance to show that they realize the health care problems faced by the average American.  And now is the time for them to show how a workable health care system would function.

Defenders of Obamacare are using the absence of a Republican alternative to suggest that the ACA is the only answer to the problems of American health care and that without Obamacare millions of Americans would have no insurance coverage.  This ends up being one of the most effective arguments for Obamacare, but conservatives and Republicans can easily take away this argument.

A workable health care system should enable people to purchase coverage and to approach health care as cost-conscious consumers shopping for insurance.  This can be done by first equalizing the tax treatment between the two types of private coverage: employer-provided and individually-obtained.  Also, the tax exclusion for employer-provided health coverage should be capped so that some people do not get a bigger tax break by buying more expensive and unnecessary insurance.  (The tax break for employer-provided insurance rewards people for choosing the most expensive insurance options.)  This would make employees more cost-conscious, which would intensify competition that would in turn make insurance cheaper.  And less expensive health care is vitally important, given that Americans spend around 18 percent of national output on health care alone.  Indeed, much of the income stagnation of the middle and working class during recent years can be explained by the growth in health costs.

To equalize tax treatment, the tax breaks for employer-provided insurance should also be available to people who do not have access to employer coverage and who purchase health insurance on their own.  This tax break would ideally be available as a refundable credit sufficient at least for the purchase of catastrophic coverage.  This would enable people who formerly chose not to buy insurance to now obtain catastrophic coverage with essentially no premium costs.

By making at least catastrophic coverage available to all, and by giving people incentives to obtain it, this approach could cover more people than ObamaCare was ever projected to reach, and at a significantly lower cost.  This alternative would not require the mandates, taxes and complex regulations of Obamacare. It would turn more people into shoppers for health care instead of passive recipients of it, and this creation of a consumer market would drive health costs down.  In such a competitive consumer market, there would be much fewer distortions of health markets by government regulation and spending than has occurred for the last several decades.

There are only two basic choices for controlling costs in health care: government-imposed cost controls, or a fully functioning competitive marketplace where consumers control the allocation of resources through their economic choices.  However, even before Obamacare came into existence, there was never a true and open marketplace in health care.  It consisted of massive and inefficient entitlements that drove the nation further into debt.  It relied on a one-sided tax treatment of employer-provided coverage that created incentives for waste and overspending.  And it contained a vastly underdeveloped individual market for those who didn’t have health care coverage from their employers.

One of the big complaints leading to Obamacare was that the great majority of Americans received health care from their employers and were afraid to leave their jobs for fear of losing their health insurance.  But the reason employer coverage became so widespread was because of a policy enacted during World War II-era price and wage controls: that employer-paid insurance premiums would not be counted as taxable income to workers.  And of course, one reason Obamacare is now so unpopular is because many workers perceive correctly that the law is increasing the costs of their employer-sponsored insurance.

This employer system was the one in place when Obamacare was passed in a climate of public anxiety about rising health costs.  In fact, the pre-Obamacare open-ended tax break for employer plans encouraged expensive, high-coverage insurance, which in turn fueled a rise in health care costs.  To address this problem, a conservative approach would set a high upper limit on tax-preferred employer-paid premiums – say, $20,000 for family coverage.  Any plan with premiums below this cap would see no change at all.  Employees enrolled in the relatively small percentage of more expensive plans would still be allowed to keep that coverage without change, but the premiums above the threshold would no longer be tax-free.

Obamacare tries to set an upper limit on the cost of insurance through its so-called Cadillac tax, which imposes a 40 percent excise tax on all employer-paid premiums above a certain threshold.  This approach is less fair because it imposes the same tax on all workers, regardless of income.  But under the conservative approach, higher-income workers would pay more for premiums above the cap because their income puts them into higher tax brackets.  Most Americans would never confront the tax, and those who did would be far better positioned to deal with it, or to change their coverage to avoid it.

A major change that a conservative health care policy would make in the pre-Obamacare system would be to discontinue the tax discrimination against people who don’t have access to employer-provided insurance and who must buy health insurance on their own.  It is not fair to give a generous tax break for health insurance to employees and their families, and nothing at all to persons who must buy insurance on their own.  A conservative approach would provide tax credits to households that don’t have access to employer coverage.  The credits would be roughly equal to the value of the tax break for employer coverage and would be refundable, meaning that taxpayers would get paid the full credit, even if the credit exceeds their tax liabilities.  And a credit is better than a tax deduction for insurance costs.  Deductions are valuable to high income taxpayers, but a credit provides the same value to all taxpayers, regardless of income and tax liability.

Obamacare tries to solve the problem of expensive pre-existing conditions by first outlawing the use of health status in setting premiums, which completely distorts a rational pricing process, and then by forcing all Americans to purchase government-approved insurance plans or else pay a new tax.  Even though this individual mandate is among the law’s most unpopular provisions, the law would not work without it, because consumers would wait until they were sick to sign up for insurance.  In fact, people may still do this, because the tax for remaining uninsured is far below the cost of insurance for most households.  Moreover, the problem of people with preexisting conditions having trouble getting insurance actually arose because federal policy has prevented the emergence of a robust individual market in which people have the incentive and the ability to buy renewable policies.

Instead of forcing people into government-mandated insurance plans, a conservative approach seeks to provide a strong incentive for consumers to stay insured.  For instance, anyone who stays continuously enrolled in insurance could be protected from higher premiums based on health status if they ever switched insurance plans.  This would allow consumers to go from employer plans to the individual insurance market without fear of higher premiums based on a pre-existing condition.  Moreover, the tax credits available to those outside the employer system would ensure that all Americans could afford continuous insurance even if they left an employer plan.  Besides providing a strong incentive to stay insured, this approach, unlike Obamacare, would help create a robust and competitive market in individual insurance.

Such a competitive market is the only way to control costs and allow the individual some power over his or her health care.  But instead of moving toward a more open consumer market, Obamacare went the other way.

Patrick Garry is a professor of law at the University of South Dakota, and Director of the Hagemann Center for Legal & Public Policy Research.

Bigger Government is Not Always the Answer—The Obamacare Example

by Prof. Patrick Garry:

Perhaps the clearest distinction between the liberal and conservative political philosophies lies in their respective focus on government as the essential booster and protector of the working and middle classes.  As Democratic Senator Charles Schumer said, a belief in government is “what unites the Democratic party,” since government is “the only thing that’s going to get the middle class going again.”  This sentiment was echoed by the Daily Beast’s Michael Tomasky: As “the party of government,” Democrats are united in the belief that “the federal government can and must intervene in the economic and social spheres to even things out.”

_MG_1317This commitment to government intervention and power reflects a central belief of modern liberalism.  It provides the consistent explanation for all the positions taken by the Democratic Party.  Indeed, it is the only explanation that justifies the Democratic support of the Export-Import Bank, which uses billions of taxpayer dollars to assist the largest U.S. corporations.  It is the only explanation that justifies the continued Democratic opposition to any school-choice programs that give poor families a chance to attend the same schools as the wealthy elite attend.  But the liberal pronouncement of government as the savior of the average person is contradicted by reality.

An example of this undaunted push for more government is the Affordable Care Act (“ACA”), its implementation, and its effect on poor, working, and middle-class Americans.  As a specific example of sweeping government power exerted in the name of the average person, the ACA and its implementation reveals that big government is often more powerful as an argument than as an actual antidote to social problems.

The Betrayed Promises of the Government Health Care Reform

Obamacare began with grandiose goals: to provide adequate health insurance to all Americans; to bring down the costs of health coverage; to free Americans from the fear of losing their health insurance if they lose their job.  And to reach these goals, the Democratic Congress under President Obama’s leadership enacted one of the most sweeping pieces of legislation in history, interjecting the federal government into every aspect of health care.

There is no question that changes needed to be made in the nation’s health care system, and there is no question that the goals of Obamacare were laudable goals.  But once the veil of needs and goals is pierced, a quite different picture of Obamacare emerges.  Instead of being an unqualified benefit to working Americans, it has turned out to be a multi-layered drag on them.

Although promising to provide the benefit of affordable health insurance to all Americans, Obamacare in reality exerts a wide-ranging hindrance on both the individual and society.  According to the Congressional Budget Office, Obamacare amounts to an implicit tax on workers that will reduce employment by as much as 2.3 million full-time jobs over the next seven years.  Obamacare’s insurance subsidies, which provide households with transfer payments to purchase health insurance, are lost as people move to full-time jobs and earn additional income.  Thus, Obamacare discourages work by making it more attractive for people to give up their full-time job rather than lose their subsidies.  According to University of Chicago economist Casey Mulligan, the rational way to capture the biggest health-insurance subsidy is to stay underemployed or even jobless.

The ACA negatively affects employment in another way, slowing growth in future years and further hurting working Americans.  The Act imposes penalties on employers, based on the number and types of employees they have.  And because the Act places a significant tax on employers who expand their business, there will be less hiring, particularly at the entry level.

Since the Act’s “employer mandate” kicks in when an employer has 50 or more full-time employees who work more than 30 hours a week, many employers have cut back their employees to 29-hour work schedules.  Even those who doubt the law will lead to a major loss in jobs acknowledge that the ACA is likely to result in a disproportionate shedding of low-wage jobs.

The group of employees most vulnerable to the adverse consequences of Obamacare are those who will almost surely be involuntarily underemployed.  According to the Bureau of Labor Statistics, there are 10 million part-time workers who now work 30-34 hours per week.  Reducing their hours to 29 will avoid the employer tax penalty, with relatively little disruption to the workplace.  And yet, according to the Medical Expenditure Panel Survey, fewer than one million of these workers will be covered by employer-provided insurance that meets Obamacare requirements.

The employer mandate has proven to be an unworkable and even destructive mistake.  Instead of prompting employers to give generous insurance coverage to their low-wage workers, the mandate pushes employers to cut back these workers to a part-time status.  Perversely, those workers who most deserve help will suffer the consequences of lower incomes with no greater access to insurance.  Moreover, by expanding coverage requirements and minimizing the risk considerations fundamental to pricing insurance, the law has already increased premiums from 20 to 200 percent in more than 40 states, according to an analysis by the Manhattan Institute.

Obamacare is also eliminating access to many of the best specialists and hospitals for middle-income Americans.  To meet the law’s mandates, major insurers are avoiding the exchanges, or only offering plans that restrict physician choices and exclude many of the best hospitals.  From 2013 to 2014 alone, the number of individual insurance offerings with restricted networks doubled, from 33 percent to 68 percent.

Meanwhile, concierge practices are increasing rapidly, as wealthy patients, along with many top doctors, try to avoid the drawbacks of an increasingly restrictive health system.  The American Academy of Private Physicians estimates that there are now about 4400 concierge physicians, 30 percent more than last year.  In a recent survey, almost 10 percent of physicians planned to move to concierge or cash-only practices in the next one to three years.

Perhaps the most ironic example of how the Act adversely affects individuals can be seen in the reaction of the Harvard faculty to changes in their own health coverage.  After being notified of increased costs, due to various Obamacare mandates, the faculty actually voted against the changes, although by this time it was much too late.  One faculty member called the changes “deplorable” and “deeply regressive.”  But it is interesting how such a solidly liberal group, which undoubtedly favored the passage of the ACA for everyone else, now objects to it when applied to themselves.

Obamacare’s Tax Increases

 By 2022, Obamacare will have imposed over $1 trillion in new taxes, with less than a third of these taxes being paid by high-income taxpayers (individuals earning over $200,000 and families earning over $250,000).  One reason for all these new taxes on middle and lower income Americans is that the Cadillac tax will increasingly hit more health plans.  This so-called Cadillac tax is the Obamacare excise tax on high-value employer health plans.  It tax imposes a 40 percent levy on individual health plans worth more than $10,200, and on family plans worth more than $27,500.

However, a recent Towers Watson survey of employers showed that 82 percent of employers expect to incur Cadillac tax liability by 2023.  Therefore, what was advertised as a 40 percent tax on a small number of “lavish” high-cost employer-provided health plans will by design evolve into a 40 percent tax on virtually every employer health plan, even those with lower than average costs.

The Cadillac tax will affect so many health plans because of how it is designed.  The threshold amounts for the excise tax are indexed to the Consumer Price Index, which according to the Congressional Budget Office will be 2.1 percent over the next four years.  But the Kaiser Employer Health Benefits Survey finds that the average cost of family coverage has risen 5.2 percent annually over the past 4 years.  Therefore, with such a large gap between the rate at which the cost of employer-provided health coverage is increasing and the rate at which the Cadillac threshold rises, eventually every employer plan will be subject to the tax.  This means that for most employers it will be cheaper to simply pay the $2000 penalty for not providing mandatory health insurance coverage and instead let workers shop on the exchanges.  And in this way, Obamacare is moving America away from a world in which employers provide health coverage and toward one in which all health coverage is purchased through the Obamacare-established exchanges.

The reason the vast majority of Americans wanted health care reform was because costs were too high, but Obamacare makes health insurance even more costly.  Yet rather than address the underlying causes of high costs, Obamacare ends up accomplishing primarily only one thing – drastically escalating government’s role in the nation’s health system.  And in fact, from 2009 to 2013, average premiums for family coverage grew by almost $3000.  This occurs in part because of another deception: that people can keep their plan if they like it, whereas in truth virtually all Americans will see mandated changes in their health insurance coverage — and these changes are further increasing the costs of coverage.

Patrick Garry is a professor of law at the University of South Dakota, and Director of the Hagemann Center for Legal & Public Policy Research.

Obamacare Closes Door to Opportunity

by Sarah Rumpf:

Recent news reports have featured a flood of stories about Americans receiving cancellation notices from their health insurance companies due to changes required by Obamacare, and many of the soon-to-be-cancelled policies are the “catastrophic” plans popular with younger people.

Is the American Dream DeadYet it’s these catastrophic plans that offer financial freedom to many young entrepreneurs. This is exactly why I insured myself this way the past few years, and why I’m saddened to see access to this type of insurance coverage sharply limited under Obamacare.

After graduating law school and practicing law for several years in Orlando, I decided to start my own business, continuing my election and campaign finance law practice and offering political and communication consulting services. In a story familiar to anyone who has ever been self-employed, I loved the freedom and flexibility of being my own boss, but had to make financial sacrifices, especially because most of my work was tied to the feast-and-famine calendar of the election cycle.

One key financial decision was the health insurance plan I chose. As a non-smoking female in my early 30s, I did not have a need for frequent doctor visits, but wanted to make sure I was covered for a major illness or injury.

My “catastrophic” plan actually covered far more than just catastrophes. The policy I obtained from Blue Cross Blue Shield provided me with not only very good coverage after the deductible was met, but also significant benefits that kicked in below the deductible, including completely covering an annual ob-gyn exam with no out-of-pocket cost to me, negotiated discount rates for doctor visits within a very broad provider network, as well as discounted prescriptions, flu shots, and other benefits.

According to my records, my deductible ranged between $2,500 and $5,000 and I paid $80-100 per month. The discounted rate for walk-in clinics was around $50-75, and doctor visits were around $100-150. Alternative policies with lower deductibles and more comprehensive care would have been between $300-500 a month, costing me an extra $2,000-$5,000 a year. I could have visited the doctor dozens of times under my plan and still never come anywhere close to paying that amount.

Beyond the absurdity of requiring women decades past childbearing years to pay for maternity care – not to mention men – Obamacare requires people like me to pay for a level of medical services that we do not want and will not use. All I wanted was to treat my health insurance as a way to insure myself against the unpredictable risk of a catastrophic illness or injury, not as a membership in a prepaid health plan.

Being self-employed forces you to be creative, thrifty, and prioritize your expenses. The extra cost of a more comprehensive plan would have been the breaking point in my budget during the leaner times between election cycles, so the best choice for me was a catastrophic plan. Had Obamacare been enacted five years ago, it would have killed my ability to pursue my dreams.

When I launched my own business, I expected to be on a different financial track than if I had stayed in the downtown law firm life, but I wouldn’t trade the last few years for anything. I’ve been able to travel around the country, attended several of the presidential primary debates in person, and had a front row seat as two long-shot candidates named “Rubio” and “Cruz” went from polling in the single digits to being called “Senator.” Now my career path has led me to a great opportunity with the Texas Public Policy Foundation working on criminal justice reform, but I would not have been able to get here without the years toiling on the campaign trail, writing freelance articles, and chasing a multitude of consulting jobs to add up to a just-squeaking-by budget.

While Obamacare’s supporters praise the expansion of “more comprehensive” policies, what is actually happening is the door to the American dream is closing for other young entrepreneurs.


Sarah Elizabeth Rumpf is the Strategic Communications Manager for Right on Crime, an initiative of the Texas Public Policy Foundation. Before moving to Texas, she ran her own election law and political consulting practice based out of Central Florida. Read more of her work at Sunshine State Sarah.

NOTE: This article originally appeared at the Austin American Statesman. It was reposted with permission.

Politics and Abortion Trump Women’s Health in California

by Teresa Ackley:

California officials rolled out a new state law that permits non-doctors to perform first trimester abortions. While the blogosphere tussles over whether the loosened regulations endanger or liberate women seeking abortions, this one woman worries that, in their fervor to see reproductive ‘justice’ done, pro-choice activists have written off some very real health risks simply because pro-lifers were among those voicing their concern.

Women's Health

Signed by Gov. Jerry Brown last Wednesday, the new law authorizes non-physicians, such as nurses and midwives, to perform aspirations, a type of first-trimester abortion that involves inserting a small tube through the cervix to remove the fetus. Before the bill was passed, only doctors could perform such procedures because many in the medical field feared that possible complications—ie. incomplete abortions, hemorrhages, infections, cervical injuries, uterine perforations, etc.—could endanger a woman’s safety unless there was someone trained to respond.

Advocates of the new law defend this looser regulation by asserting that it will expand access to cheaper reproductive services (aka abortions), particularly for the 1% of California women who live in rural counties without an abortion provider. They claim that the rate of complications during aspirations only had a marginal increase when performed by a non-physician and, more pointedly, that the hysteria over lowered standards of care was driven primarily by anti-abortion propaganda.

This seemed to be the central talking point throughout the legislative debate. A skeptic would question whether the expanded access merited the potential health risks, and the pro-choice lobby would dismiss these concerns as utterly disingenuous, not worthy of a retort.

Let me confess, I understand why pro-choice activists might want to question the motive behind laws that restrict access to abortion under the guise of advancing a woman’s health. There is certainly a cheering section of the pro-life movement that recognizes that these types of objections are a backdoor to cutting, if not ending, the number of abortions nationwide, just as they recognize that these same concerns can be used to thwart new legislation aimed at expanding abortion access.

However, just because medical risks are sometimes co-opted by a political opponent, does not mean that those risks are nonexistent. Abortion, regardless of its morality or lack thereof, is at its heart a medical procedure and, as such, has all the inherent risks and complications associated with surgery. California’s new abortion law is not exempt. Skeptics have every reason to question a law that potentially ranks convenience over the safety of women.

Don’t believe me? Just take a look at the study California policymakers and pro-choice activists relied upon. The new law treads on the heels of a UC San Francisco survey that implemented a type of pilot program, where non-doctors performed first-trimester abortions at some 22 sites. These results were then compared with those procedures performed by experienced doctors.

The findings left many questions unanswered. The study found that non-physicians had a complication rate of 1.8 % as compared to the .9% complication rate under physicians. Tracy Weitz, the associate professor in charge of the study and trained social scientist, interpreted these results as a statistical dead heat and deemed the procedures “enormously, incredibly safe.” Pro-choice policymakers were quick to follow her lead.

Forgive me, but I’m not convinced. Even ignoring the relative ability of non-doctors to appropriately respond to severe and unexpected mishaps, the results of the UC San Francisco study show a real difference in the rate of complications between physicians and clinicians, one that’s almost double. Admittedly, as written (.9% versus 1.8%), the distinction appears tiny, but when written as a ratio and then projected over the number of Californian women who obtain aspirations per year, the number starts assuming an ominous tone.

As a ratio, the difference is 1 out of 100 women who visit a doctor versus 1 out of 50 women who sit before a clinician. When projected on the approximate 160,000 Californian women who seek an aspiration per year, that number becomes 1,600 cases compared to 3,200. That means over 1,600 additional women face a life changing tragedy, all because pro-choice activists elected to slacken the law in order cut down on someone’s driving time.

Now, I won’t question the motive behind the new law, nor will I do its supporters the disservice of assuming that their need for a moral victory in the face of other legislative defeats drove them to ignore their own self-claimed constituency. I honestly believe that they thought that this new law would advance the medical health of women and that their eyes were just so focused on the destination that it made them blind to the hazards on the road.

Rather, if you ask me, pro-choice activists made one of the simplest mistakes in politics, and possibly the worst mistake they could make in the abortion debate. First, they judged and then dismissed real concerns over the safety of law, based not the merits, but on the identity of the speaker. They let themselves get distracted by their own press releases.

Second, they conflated the idea of healthcare with abortion. Again, this is not to suggest that abortion doesn’t play a role in feminine health (although we can debate that later). But, there is more to a woman’s health than access to abortion alone, even if that access plays an important role. Legislatures also need to be concerned with the quality that service takes. It’s here where the pro-choice movement failed.

Pro-choice policymakers, and the activists behind them, cannot let the narratives driving the abortion debate blind them to genuine worries over their proposed laws. Otherwise, we will soon find ourselves in more situations where politics and abortion trump a woman’s health.


Teresa Ackley is a human rights lawyer based in Washington, DC.

Obamacare’s Fine Print

by Katherine Restrepo:

It has been several days since ObamaCare’s health insurance exchanges launched for enrollment.  Individuals can now purchase federally qualified health plans from participating insurers.  People with pre-existing conditions can no longer be denied coverage.


Sounds good so far, right? Not so fast.

If you decide to sign up for a heavily regulated heath insurance plan, look past the political debates (and the technological glitches), and take a closer look at the fine print.  It’s worth the observation.  These Obamacare health plans are infested with ugly, unintended consequences.  Consumer choice and individual rights walk on a tight leash, and the desire to pursue health care at one’s discretion has now morphed into a collective social responsibility.

The Fine Print

The establishment and rollout of ObamaCare’s health insurance exchanges intends to provide individuals with affordable plan options offered by an array of participating health insurers.  Sounds like some solid competition and choice.  But, of course, all is not what it seems.  Health insurance exchanges limit consumer choice due to three key reasons:

1. Required Benefits: Any health plan a consumer decides to purchase, whether it be inside or outside the exchange, must include 10 Essential Health Benefits as mandated by the federal law.

2.  Narrow Networks: It seems that, for states with at least half a dozen insurers on the exchanges, the availability of more plans will also yield competitive prices.  What goes unsaid is that lower monthly premiums mean narrower provider networks, higher out-of-pocket expenses, and providers paid at Medicare levels.

Last week’s New York Times wrote:

Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.

The Daily Caller contributes to the issue as well:

Missouri: Patients of the state’s largest hospital system — which spans 13 hospitals including the St. Louis Children’s Hospital — will not be covered by the largest insurer on Obamacare exchanges, Anthem BlueCross BlueShield. Anthem covers 79,000 patients in Missouri who may seek subsidies on Obamacare exchanges, but won’t be able to see any doctors in the BJC HealthCare system.

Looking at this issue from another angle, roughly 70% of physicians are now employed by hospital systems.  There was a time when the majority of medical providers practiced independently.  Ten years ago, this statistic was flipped, as only 30% of physician groups worked for these health systems.

Since a majority of physician practices are now under the ownership of this excessively consolidated market, if major hospital systems are not within an exchange plan’s provider network, then patients may not have access to the quality providers who work for that hospital system.

3. Small Number of Providers: In many jurisdictions, only a limited number of companies offer plans under the exchanges, limiting the choice consumers have for healthcare. For example, in North Carolina’s exchange, only two insurance companies, Coventry Health Care of the Carolinas and Blue Cross and Blue Shield of North Carolina, have signed up to participate in North Carolina’s federally-facilitated exchange.  Blue Cross and Blue Shield already controls 85% of the individual market and is the only insurer offering plans in all 100 counties of the state.  Coventry Health Care, meanwhile, offers plans in just 39 counties.

Just as the structure of the exchanges limits individual health care freedom, the associated costs of these bloated, subsidized health plans will restrain eager individuals from signing up for coverage. And even if an uninsured individual decides to opt out, the individual mandate tax of either $95 or 1% of income, whichever the greater, will be dispersed back into the collective healthcare system. The exchanges may be open for business, but the critical question is: “For how long?”


Katherine Restrepo is the Health and Human Services Policy Analyst at the John Locke Foundation. She graduated Phi Beta Kappa from McDaniel College with a Bachelors of Arts in Political Science and Spanish