By Lambert Strether of Corrente
And we go to Happyville, instead of to Pain City. –Thomas Pynchon, Gravity’s Rainbow
In a six-part series on “ObamaCare’s relentless creation of second-class citizens,” I showed how people seeking health care through ObamaCare’s exchanges get randomly varying access to care because of age, geography (state and county), income, employment status, banking status, internet access, existing insurance status, language, demographics, and by CMS marketing category (1, 2, 3, 4, 5, and 6. In addition, people “on the bubble” for income eligibility are incentivized to corrupt the system by gaming it.)
These variations are in great contrast, both morally and economically, to single payer’s “everybody in, nobody out” model. None of these variations are in any way fair, or encourage equal access to health care, which Obama seemingly concedes is a right; they exist solely because of Obama’s determination to preserve the private insurance industry’s actuarial model, even though the private insurance industry is a wholly parasitical, rent extracting tapeworm on the body politic. All this would be true even the supposedly tech savvy Obama political operation had not turned healthcare.gov into the debacle it has been.
Be that as it may, the administration has now added yet another whimsical and arbitrary misfeature to Obama’s “signature domestic initiative.” David Lauter of the LA Times explains why some people who were going to Pain City are now going to Happyville!
Under the new policy, people who have received notices that their health plans are being canceled would qualify for allowed by the law. Under those exemptions, they could buy low-cost catastrophic health plans or skip buying health coverage altogether.
It’s worth noting that the rule change was not motivated by public policy, but — and I know this will come as a surprise to you — purely by political considerations.
The new policy stems from one of the biggest political problems Obama has faced with the troubled rollout of the healthcare law — his promise that the people who liked their existing health plans could keep them. When several million people nationwide began receiving notices that their plans would be canceled because the plans fell short of the new law’s requirements, Obama suffered a sharp drop in public trust.
Democrats in Congress, especially senators facing tough reelection challenges next year, were bitterly upset at the predicament in which Obama’s words had placed them. They have pressured the administration to respond to angry constituents.
Why is this important? (Consumer Reports, disgracefully, simply uses the story as click bait for its eligibility calculator.) Because the key feature of ObamaCare is “the marketplace” (the exchanges) and the individual mandate that forces people to buy products from that market, in order to guarantee the health insurance industry customers for the foreseeable future. But this new hardship exemption blows a hole in the mandate. Reuters:
In the law, there are 14 categories of “hardships” that can be used to get an exemption from the mandate to buy insurance, such as a recent eviction or bankruptcy. But this is the first exemption prompted by the administration’s botched rollout of the law, and comes after months of insistence that there would be no delays in implementing the individual mandate.
No delays except for everybody and his brother who already got a delay, like employers, small businesses, health insurance companies, name it. Everybody but you. Until now! Again, needless to say, this delay is has no coherent basis whatever in ethics or policy. Even Ezra Klein is aghast:
A 45-year-old whose plan just got canceled can now purchase catastrophic coverage. A 45-year-old who didn’t have insurance at all can’t. Why don’t people who couldn’t afford a plan in the first place deserve the same kind of help as people whose plans were canceled?
Why, it’s almost like people who might cause Democrats electoral problems are a protected category, isn’t it? If lack of coverage for enough people like you makes Obama look bad, you’ve got a hardship. You’re a winner, and you get a ticket to Happyville! See how simple Federal rule-making can really be? Here’s how the exemption works, according to WaPo:
2. According to HHS, the exemption covers people who “experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan.”
Now, if I were Pajama Boy, that lovable little scamp, and I wanted to beat back my Obot Mom’s Christmas assault, I might reason in this way:
[thinks] Hmm…. “unexpected … human-caused event” — that would be ObamaCare — with an “unexpected increase in essential expenses” — that would be the cost of ObamaCare, ’cause yeah, my Mom says it’s essential… “prevent… from obtaining coverage”… Yeah! The narrow networks definitely prevent me from obtaining coverage. Because they’re narrow!
“Hey Mom! I’m going to Happyville! The HHS says that if the plans I’m eligible for are lousy, I get a hardship exemption!”
And seriously, if you’re going to give a hardship exemption to the cancelees, why not give a hardship exemption to the sticker-shocked? (Or, as we might say, the informed consumers who put in the many hours needed to figure out if the plans on the Exchanges were any good or not.)
I hate to quote a stopped clock like Megan McArdle but give credit, she got it right on the Exchanges when all the Obots were either silent or waving their pom poms, so here she is on the political implications:
However incoherent these fixes may seem, they send two messages, loud and clear. The first is that although liberal pundits may think that the law is a done deal, impossible to repeal, the administration does not believe that. The willingness to take large risks with the program’s stability indicates that the administration thinks it has a huge amount to lose — that the White House is in a battle for the program’s very existence, not a few marginal House and Senate seats.
And the second is that enrollment probably isn’t what the administration was hoping. I don’t know that we’ll start Jan. 1 with fewer people insured than we had a year ago, but this certainly shouldn’t make us optimistic. It’s not like people who lost their insurance due to Obamacare, and now can’t afford to replace their policy, are going to be happy that they’re exempted from the mandate; they’re still going to be pretty mad. This is at best, damage control. Which suggests that the administration is expecting a fair amount of damage.
Oh, and the dishonesty and immorality of treating politically useful segments as protected categories was built into ObamaCare from the very beginning: That’s why asbestos sufferers in Baucus’s district got Medicare, and not people with chronic diseases anywhere else. And Libby’s website, naturally, worked from day one.
 And how true, how very true that is.
 Obama keeps insisting otherwise, notably at his latest presser, but of course he’s lying. Again. The mandate and the exchanges are the only “core” features of ObamaCare; take them away, and all the other reforms, like children to 26 on their parent’s policies, or pre-existing conditions, could have been enacted as standalone pieces of legislation. It’s the exchange and the mandate that make ObamaCare ObamaCare — all the more because Obama ran against them in 2008, which Krugman called “poisoning the well for health care reform.” Had we but known.
 I meant to say, avoid the “free rider” problem. Sorry.