John Goodman had an excellent post yesterday discussing the coming challenges in implementing the Affordable Care Act. One of his major points is that the Affordable Care Act makes health insurance less affordable:
Adding to the problem is that the law will require all of us to have access to a long list of preventive services without deductible or copayment. Economists at Duke University calculated that if every American actually got all of the recommended screenings and tests, the average primary care physician would have to spend 7 ½ hours of every working day doing nothing else but giving preventive care to mainly healthy patients!
The whole, relatively short, piece is worth reading.
John left out, though, one of pressing challenges, the one about exchanges. Economist Michael F. Cannon and law professor Jonathan H. Alder have laid out the issue here. The abstract:
The Patient Protection and Affordable Care Act (PPACA) provides tax credits and subsidies for the purchase of qualifying health insurance plans on state-run insurance exchanges. Contrary to expectations, many states are refusing or otherwise failing to create such exchanges. An Internal Revenue Service (IRS) rule purports to extend these tax credits and subsidies to the purchase of health insurance in federal exchanges created in states without exchanges of their own. This rule lacks statutory authority. The text, structure, and history of the Act show that tax credits and subsidies are not available in federally run exchanges. The IRS rule is contrary to congressional intent and cannot be justified on other legal grounds. Because the granting of tax credits can trigger the imposition of fines on employers, the IRS rule is likely to be challenged in court.
It strikes me that what the IRS is doing is clearcut illegal. If courts pay attention to, you know, the actual law, they will have a hard time upholding the IRS. Then a large part of the structure of ObamaCare would go away.