Originally posted at the Alaska Dispatch Network on June 20, 2015

Can Alaska Afford to Expand Medicaid?  Can It Afford to Trust Obama?

It is hard not to chuckle when you read political satirist P.J. O’Rourke’s observation about the nation’s health care system as Bill and Hillary monkeyed with it: “If you think health care is expensive now, wait until you see what it costs when it’s free.”

He could have been talking about Obamacare or Medicaid, the latest break-the-bank effort to “fix” the system. Since 2010, Barack Obama has lied to Americans about his signature achievement — taking the first, long step toward socialized medicine in an unending, unconstitutional game of three-card monte.

Obamacare is a lie. You can keep your doctor, he said. You can keep your health plan. It will save families $2,500 a year. Costs will not increase; those in need will be able to afford health care.  Any of that sound familiar?

Even the bill creating Obamacare, the 2010 Patient Protection and Affordable Care Act mandating Americans buy insurance or be penalized, is a bold lie designed to trick Congress, its fiscal watchdog and the American people.

“This bill was written in a tortured way to make sure CBO (Congressional Budget Office) did not score the mandate as taxes,” Obamacare architect and MIT professor Jonathan Gruber told an audience with a smile. “If CBO scores the mandate as taxes, the bill dies. Call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass.”

He dismissed the lies as an “advantage” and said he did not care about them — so long as the bill passed.

There are those who want Medicaid expanded in Alaska on Obama’s word. His word, unsurprisingly, is worth zip, nada, squat — and 9.6 million Americans may soon see that, with 8 million of them, the Rand Corp. estimates, ending up without insurance if the Supreme Court in a critical case actually upholds the Constitution and makes the federal government follow the law. The states hit hardest? Florida and Texas. What about Alaska? Such a decision could cost 16,000 Alaskans $8.8 million in insurance subsidies each month.

It all falls to the Supremes — yes, the same bunch that breathed life into Obamacare by pretending an unconstitutional penalty is a constitutional tax. The court soon will decide King v. Burwell, a case that may gut insurance premium subsidies through federal health exchanges — such as Alaska’s — in at least 34 states.

The affected states declined or failed to establish their own exchanges under Obamacare. The lawsuit plaintiffs agree Congress intended a federal premium subsidy — but only for lower-income Americans who bought insurance on state exchanges. They base that on four words in the Affordable Care Act granting the credits to exchanges “established by the state.”

The Internal Revenue Service, emblematic of this lawless administration, allowed the tax credit for all financially eligible Americans who bought insurance on state-run or federal exchanges.

There have been legal challenges to the IRS action with conflicting outcomes in two different appellate courts — the Fourth Circuit, in King v. Burrell, which favored subsidies in federal exchanges, and a D.C. Circuit three-judge panel that ruled, in Halbig v. Burwell, against them.

If the justices kill the subsidy, the recent Rand Corp. report concludes, eliminating subsidies in all states would cause enrollment in the “ACA-compliant individual market to drop by 13.5 million, or 68 percent, and result in a 43-percent spike in premiums in the individual health insurance market.”

In Alaska, the only two companies left offering such insurance, Premera Alaska and Moda Health, already want hefty increases of 39 percent and 22 percent respectively.

Also at stake for Obamacare backers is the so-called individual mandate, the system’s linchpin that required Americans to buy insurance or pay a “tax.” Without it, with no way to force Americans to buy insurance, Obamacare dies.

Across the board, Obamacare has been problematic, something Alaskans should be thinking about because the same bunch that jammed Obamacare down our throats pretends Medicaid expansion here will be smooth sailing; that the federal government will step up and pay all of the expense until 2016, and then at least 90 percent after that.

In a state with $2 billion in income and $3 billion in wants, a state fighting to the death over cutting only a tiny percentage of its budget, a state with nearly half its annual operating budget already eaten up by the Department of Health and Social Services, can we afford Medicaid expansion?

The real question: Can we trust Barack Obama?

If you can say yes to that, you have a larger problem than expanding Medicaid.

Much larger, indeed.

Paul Jenkins is editor of the AnchorageDailyPlanet.com, a division of Porcaro Communications.

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