Health and Human Services Secretary Kathleen Sebelius told several hundred legislators and state health officers Monday that resistance to the 2010 health-care overhaul should end, and that they can play a role in implementing the still hotly debated act.

“This is no longer a political debate; this is what we call the law,” Sebelius told a group that includes Democrats and Republicans, elected officials, political appointees and bureaucrats. “It was passed and signed three years ago. It was upheld by the Supreme Court a year ago. The president was re-elected. This is the law of the land.”

***

First, there was the delay of Obamacare’s Medicare cuts until after the election. Then there was the delay of the law’s employer mandate. Then there was the announcement, buried in the Federal Register, that the administration would delay enforcement of a number of key eligibility requirements for the law’s health insurance subsidies, relying on the “honor system” instead. Now comes word that another costly provision of the health law—its caps on out-of-pocket insurance costs—will be delayed for one more year

There’s no such thing as a free lunch. If you ban lifetime limits, and mandate lower deductibles, and cap out-of-pocket costs, premiums have to go up to reflect these changes. And unlike a lot of the “rate shock” problems we’ve been discussing, these limits apply not only to individually-purchased health insurance, but also to employer-sponsored coverage…

The best part in Pear’s story is when a “senior administration official” said that “we had to balance the interests of consumers with the concerns of health plan sponsors and carriers…They asked for more time to comply.” Exactly how is it in consumers’ interests to pay far more for health insurance than they do already?

It’s not. Unless you have a serious, chronic condition, in which case you may benefit from the fact that law forces healthy people to subsidize your care. To progressives, this is the holy grail. But for economically rational individuals, it’s yet another reason to drop out of the insurance market altogether.

***

Sebelius and her colleagues in the White House may not like that Republicans are not eagerly lining up to assist the White House implement a law that they have always opposed. But their major forms of opposition—declining to expand state-based Medicaid programs, refusing to build state-run health care exchanges, saying mean things about the law—are all perfectly legal. This is true even if you think they are not serving the public, are not behaving with dignity, or are simply very bad people. The law, in combination with the Supreme Court’s Medicaid ruling last summer, gives Republican governors the ability to opt out of creating their own exchanges, and allows them to keep their current Medicaid programs without fear of penalty.

It is the Obama administration which has chosen to ignore the law of the land by selectively enforcing provisions, encouraging government agencies and ignoring clear legislative language that conflicts with the administration’s goals. The administration’s delay of the employer mandate, for example, is not supported by statute. And when questioned about his administration’s authority to enact the delay, Obama has not even tried to claim that it is; instead he has simply asserted the authority to delay the provision, and then returned to criticizing Republican opposition. When Republicans in the House voted to give Obama explicit authority to delay the provision, and to delay the individual mandate as well, he issued a veto threat…

And then there is the matter of the law’s insurance subsidies. The text of the law states only that these subsidies are available in exchanges created by states. Yet the administration has embraced a ruling by the Internal Revenue Service that allows the subsidies in the 34 exchanges run by the federal government.

Does the Obama administration believe that Obamacare is the law of the land—or that the law of the land is whatever the Obama administration says it is?

***

The wealthy and well-connected seem to be having a much better go of getting exemptions from Obamacare…

Today, as the law lurches into full implementation, we learn that the administration has imposed another delay in a key provision of the law, this time to help the profits of those same insurance companies he once attacked…

One of the upsides of having lobbyists present at the creation of the law and now having so many members of team Obama on the other side of the revolving door is that the lobbyists know just where to go to get what they want. What about the 2009 and 2010 promises from Obama and his health law team, particularly Health Secretary Kathleen Sebelius, that they would smack down insurance companies who sought big rate hikes? Why didn’t they just tell insurance companies to pay for it out of their cushy profits?…

Obama has so far spared big business, big insurance and members of Congress from expensive provisions of the law. For regular folks, including the same union members who helped pass and protect the law, the exemptions don’t come so easily.

***

A woman in Cornelius, Ore., takes care of her disabled 22-year-old daughter. The daughter has cerebral palsy, spina bifida and a condition called automonic dysreflexia. She requires 24-hour care. The mother provides it, receiving for this $1,400 a month. The mother fears—and is apparently right to fear—a provision of the Affordable Care Act that will, as Zheng reports, “largely prohibit guardians from serving as the paid caregiver of an adult child with developmental disabilities.” The mother is afraid this will mean foster care for her daughter, or a lengthy and costly process in which she herself will be forced to transfer legal guardianship to someone else. The provision, the paper says, will likely cause hardship for hundreds of Oregon families in which the guardian and the caregiver are the same person.

Oregon officials are asking the administration for an exemption to the provision.

Four points. First, no mother or child should be put in this position by a government ostensibly trying to improve their lives. Second, everyone in America knows health care is a complicated and complex subject, that a national bill will have 10 million moving parts, and that when a government far away—that would be Washington, D.C.—decides to take greater control of the nation’s health care it will likely get many, maybe a majority, of the moving parts wrong. A bill that is passed and is meant to do A will become Law U—a law of unforeseen, unplanned and unexpected consequences. And that’s giving Washington the benefit of the doubt, and assuming they really meant to honestly produce Law A. Third, because health-care legislation is so complex, it is almost impossible for people to understand it, to get their arms around what may be a given bill’s inadequacies and structural flaws. Stories of those inadequacies and flaws dribble out day by day, in stories like this one. They produce a large negative blur, and a feeling of public anxiety: What will we find out tomorrow? The administration reacts, as the president has, with protestations about how every large, life-enhancing bill has hitches and bumps along the way. But this thing looks now like one large hitch, one big and never ending bump. Fourth, when a thousand things have to be changed about a law to make it workable, some politician is going to stand up and say: “This was a noble effort in the right direction but let’s do the right thing and simplify everything, with a transparent and understandable plan: single payer.” Will that be Mrs. Clinton’s theme in 2016?

***

As a presidential candidate, he said his reform would lower premiums for families by $2,500 on average. He maintained that the only change for people already with insurance would be cheaper premiums. During the congressional debate over the law, arguments to the contrary were pooh-poohed and scorned by the president’s allies.

Today, those arguments have been vindicated. Avik Roy points out that one PricewaterhouseCoopers study in 2009 that found premiums in the individual market would increase by 47 percent during the next few years was derided by the Left, but may have been too modest in its projection. Yet the president still speaks as if premiums are only going down. Years ago, it could have been chalked up to wishfulness and ignorance of how insurance markets work. Now, it’s simply refusing to acknowledge reality…

At least liberal analysts are willing to admit that premiums are going up, which the president can’t yet bring himself to do. Jonathan Cohn, a staunch defender of the law at The New Republic, lamented the president’s misleading remark at his press conference. He wrote of average listeners: “They’d come away thinking their insurance will be cheaper next year. For some, it won’t be. Obama isn’t doing himself, or the law, any favors by fostering a false expectation.”

But that false expectation, surely, is the entire point, and always has been.

***

***

***