On the Third Hand: Halbig and King

Another question is whether HHS will make the PPACA restrictions on use of personal health information in the pricing and sale of health insurance stick in states that can’t offer PPACA coverage subsidies. Maybe not.

Once the world settles down, we could end up with a nation of PPACA states and non-PPACA. In the Blue and Purple PPACA states, unsubsidized coverage will be expensive, but poor people and sick people will have easy access to coverage — possibly thanks to taxes paid by taxpayers throughout the country. 

Residents of Red non-PPACA states may have access to cheap private coverage if they are young and healthy, but little access to Medicaid, and no access to affordable private coverage if they are broke or sick. Or, if the PPACA underwriting rules apply in states without either Medicaid expansion or QHP subsidies, residents may have no access whatsoever to affordable coverage. The only people who will have any health insurance in those states may be rich people.

The trend for decades has been for vigorous young workers to move from Blue Rust Belt states to Red Sunbelt states. If Blue states become the states where people have access to health insurance (even expensive, rickety, annoying health insurance), maybe that trend will reverse, and Red state workers — especially those with any chronic health problems — will flood into the Blue states. Or, if they stay in their states, they may ask why the people across the state line can go to the doctor and they can’t.

On the one hand, from the perspective of anyone who is open-minded enough to want any PPACA that exists to be the best PPACA it can be, the enemy here is the very liberal Democrats who pushed President Obama to shift to an entirely government-run health care system when he was first elected. If those very liberal Democrats had let Obama and congressional leaders propose a bill that could have gotten past moderate Democrats in the Senate from the start, Obama might have been able to sign a version of PPACA that was flawed but that had least gone through proofreading.

As it was, we’re lucky the final version of the bill didn’t include a provision outlawing chocolate. It’s not clear that anyone would have caught that provision if it had been in the text.

On the other hand, whatever the problems with PPACA itself might be, the idea that Blue state residents might get whatever benefits there are to be had from PPACA, and Red state residents would help pay for those benefits without enjoying the benefits, seems strange.

On the third hand, the irony could be that, if this goes on private health insurers will continue to operate with some headaches, but pretty well, in the Blue PPACA states, and that the Red non-PPACA states will eventually have no choice but to cope with the chaos in their health insurance markets by offering Medicaid for all.