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Tuesday, March 19, 2019

The Affordable Care Act

On March 23, 2010, Obamacare — formally known as the Patient Protection and Affordable Care Act — was signed into law by President Obama.

Three years later, the bulk of the first serious attempt at near-universal health care in the history of the United States has not yet taken effect. Health marketplaces are still being formed, states are still deciding if they’ll take Medicaid expansion and the subsidies that will help tens of millions of Americans afford health care won’t roll out until January 1, 2014.

Implementing Obamacare won’t be easy, as even some of the biggest fans of the program admit. Expanding Medicare to cover all Americans would have to be an even simpler solution but a complete political impossibility — given that Joe Lieberman (I-CT), whose vote was necessary to pass the law, single-handedly vetoed a provision that would allow 55- to 64-year-olds to buy into the single-payer insurance plan that covers all seniors. It’s a compromise solution that uses unpopular provisions — like the individual mandate — to achieve extremely popular results — ending lifetime limits and banning insurance companies from dropping patients once they become sick.

And the most popular provisions of the law are its least well known.

There will be plenty of time to debate the efficacy of Obamacare — especially with insurance companies enjoying record profits threatening to raise rates in order to justify changes to the law.

But right now we should celebrate the greatest victory for the middle class since Medicare and Medicaid. At its heart, Obamacare is a program that asks the rich and corporations to pay a little more to help working Americans get insurance they can count on, thus lowering the cost of health care for everyone. We already pay for each other’s health coverage, but just in the dumbest possible way — emergency rooms. And the law will certainly help save thousands of the more than 26,000 Americans who die every year for lack of insurance.

Here are five reasons to be grateful for Obamacare, which is already making life better for the middle class.

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36 responses to “On Obamacare’s Third Birthday, 5 Reasons To Be Grateful”

  1. donbronkema1 says:

    Some day we’ll get smart & enact Single-Payer, like every place on this beleaguered planet not contaminated by supply-side, trickle-down greed & plutocracy.

  2. Ed says:

    I hope I live to see it! But I don’t know.

    • dtgraham says:

      I wasn’t going to make any comments, but I’ve just taken my wife into a hospital and I thought I’d share a little of the experience to show the political right that single payer, socialized medicine isn’t the demon they think it is. This isn’t for Ed or donbronkema1.

      It’s a beautiful, plush, modern hospital. It’s not some ramshackle building that I’m sure the right envisions. There are specialized oncology and dialysis units attached to it and this hospital can do any procedure. She’s been put through a battery of tests, with more to come, using some very expensive equipment. She’s really getting the best of care and I have nothing but praise for this hospital.

      She may be in for up to one or two weeks, but regardless of how long they keep her, my total bill will be $130.00 for everything. That was the cost of the city ambulance to pick her up and take her there. There’s no fee for anything else. Medicine for profit is illegal in Canada due to the provisions of the Canada Health Act. There are no monthly health care premiums to pay either. It’s all financed out of general taxation, not on a payroll basis. When you get every working person contributing into the system and get the private sector and the profit motive completely out of it, costs can really be driven down.

      We’ve always been healthy people and had no real exposure to the health care system. We just kind of took it for granted that it was there. Since Theresa became disabled in 2009, I now am aware of the almost embarrassment of riches that single payer can provide and actually feel guilty sometimes. Four years ago I first took her into a hospital and I was wondering how much certain equipment for disabled people, in our house, (like a specialized bed) was going to cost me. To my amazement some nice government people showed up at our house later with a special bed and toilet facilities…for free. I hadn’t even asked for it and wasn’t aware that such a service existed in our system. When she comes home, she’ll apparently be getting some kind of scooter device at no charge and a home care worker will pop in once a day to check on her when I’m away, and do whatever else they do. Again, no charge. I actually felt a little embarrassed about this but they insisted that this should be done. I think I’m going to be making some charitable donations or something to that hospital. I pay my taxes for all of this but it almost feels as though you should contribute a little extra if you’re able, although they’re not allowed to accept the money in that way.

      At any rate, I can’t speak for others but this has been my experience. I think President Obama is a great man and the ACA is a marvelous improvement by itself alone. Who knows where it may eventually lead to, but if it does lead to single payer that’s a terrific system too. I now know it.

      I’m going to try to get some cost numbers for all of my wife’s care. I’ve no idea what all of this costs but, if I can, it might be interesting to compare them to the same procedures and length of stay in a U.S. hospital. I’ll get back to you guys if I can come up with this.

      • plc97477 says:

        I wish your wife well. The lack of cost makes it better but even then it is hard to take when a loved one is in the hospital

        • dtgraham says:

          Thank you plc. I am increasingly concerned about Theresa but at least medical bills don’t add to my worries, as you point out. There aren’t any. Thanks again my friend.

      • charleo1 says:

        I for one, enjoyed reading of your experiences with a single pay
        system. And wish for your wife, all the very best. Now, our Right
        Wing politicians know we are being ripped off in this Country by the
        big insurance, and drug companies. And they know thousands die
        every year for lack of care. But, as you may have noticed, we here
        in the U.S., have had our Government, just about bought out, by the
        various corporations. And, it’s a bit embarrassing to say. But what is
        best for the people in America today, is always the very last thing
        considered. That’s if it’s considered at all. I think we have a good
        President, but there’s only so much he can do. I guess you heard
        about our banks? Like every other big business here nowadays.
        They don’t want competition, or regulation. And have very little of
        either one. And that’s fine with the Government. The problem is,
        most of the rest of us, are becoming paupers in our own Country
        because of it. I was thinking just the other day. if I was a Canadian,
        how down right proud I would be, that my Government wouldn’t
        allow the banks up there, to get involved with the kind of reckless
        gambling our banks were allowed to engage in here. But, don’t
        get me wrong. I’m glad you have a Government that still cares about
        it’s people. And as people go, the Canadians I’ve had the pleasure
        to meet, are some of the nicest folks in the world. So, don’t forget
        to let us know once in a while, how your wife is getting on. We’ll look
        for your comments!

        • dtgraham says:

          I’m overwhelmed here. Thank you charleo1 and plc97477. Thanks for your kind comments. You’re right on about those banks charleo1. I remember when Clinton gave in to Republican pressure and put the finishing touches on bank deregulation with the end of Glass-Stegall in the 90’s. That put the final kibosh on Roosevelt’s reforms of the 30’s. It was as though no lessons had been learned from history.

          At that same moment, Canadian chartered banks were whining that they weren’t able to participate in this new proprietary trading market. They saw what was happening south of the border and they also wanted to get involved with the usage of “excess deposits” in risky bets utilizing the derivatives and credit default swap markets that were opening up, instead of investing in safe things like treasuries.

          We had a Liberal Party finance minister named Paul Martin at that time who was utterly opposed to the whole idea and would hear of none of it. He insisted that Canadian banks not engage in any of this behaviour and instead make their money the old fashioned way. The guy was a visionary and saved Canada from what was to come.

          You know, I’ve also had the pleasure of meeting a lot of Americans through my work over the years. Politics is a funny thing charleo1. I used to always say that Americans from the mid west and the south were some of the finest gentlemen and ladies that I ever met in my life, and would put a lot of Canadians to shame. I probably would have violently disagreed with their political beliefs, but on a personal level they were awfully nice and classy people.

  3. empiremed says:

    Obamacare has been law for nearly three years, with its anniversary approaching on March 23. And while the major provisions (exchange subsidies and Medicaid expansion) aren’t slated to begin until 2014, Obamacare is already having devastating effects on Americans and their health care.

    Recall that fateful Presidential promise, made on several occasions during the health care reform debate, “If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”

    Despite the President’s promise, Heritage warned that many provisions in Obamacare would encourage employers to drop health coverage for their workers:

    Many businesses and their employees—especially lower-income employees—will find that replacing ESI [employer-sponsored insurance] plans with subsidized coverage on the exchanges is mutually beneficial. Employers would no longer offer health insurance but would offer wage increases as wages and benefits are substitutes in an employee’s net compensation. At the same time, these workers will still have access to coverage through the exchanges with the subsidies or through Medicaid.

    Heritage had it right. As employers and businesses prepare for the law’s major insurance regulations and mandates to begin next year, more stories of people losing their current coverage are emerging.

    Most recently, Universal Orlando announced that it will no longer offer coverage for its part-time workers. The reason is Obamacare’s prohibition of annual benefit limits beginning in 2014, causing Universal’s plans to become too expensive. It’s estimated this will affect about 500 Universal employees. But the law began phasing out annual limits over the past few years, which Universal—along with 1,230 other health plans—had a waiver for. However, those waivers expire January 1, 2014, and the likely outcome will be that the nearly 4 million Americans enrolled in those plans will be forced out of their current health plan.

    Another group who will lose their current coverage in 2014 is the American Veterinary Medical Association (AVMA). According to a news release, “[M]edical coverage will end for some 17,500 Association members and thousands of their dependents at year’s end.” The underwriter of AVMA’s medical coverage blames “regulatory requirements put in place as a result of the Patient Protection and Affordable Care Act signed by President Obama in 2010.” However, the Association plans to offer other coverage by operating its own private exchange in 2014.

    There will likely be many more of these stories over the next few years, as the Congressional Budget Office projects that, on net, 7 million Americans will lose their ESI by 2022 due to the enactment of Obamacare.

    Worse yet, there are plenty of other studies that predict the loss of ESI will be much greater. McKinsey & Company, a consulting firm, found that “30 percent of employers will definitely or probably stop offering ESI in the years after 2014.”

    Deloitte, another consulting firm, found that around 10 percent of employers would drop coverage and send their employees into the new government-run exchanges.

    While these results vary in severity, they all mean that Obamacare will cause millions of Americans to lose their current health care coverage—which is just one of Obamacare’s many broken promises.

    • The President did not and COULD NOT promise that greedy bosses would not take away part of the benefits of the new law. And unfortunately, the way AROUND what those greedy bosses are doing — the new health insurance exchanges and subsidy for lower income people — was delayed at the insistence of the GOP and DINO Senator Lieberman until 2014, obviously so that we would have to “pay in advance” and the up front payment would scare people out of re-electing the President. It may have had the opposite effect, because the Obama campaign appealed in part to people who had suffered the bad side effects already and were waiting for the good stuff. The campaign reminded Americans that repealing Obamacare in 2013, as MR would have done with a GOP Congress, would be, in essence, leaving the table after paying in advance for a Porterhouse steak.

      After we have been able to get that first, expensive, prepaid steak, subsequent steaks will, in fact, probably be cheaper. And with unemployment going down (although less than desired because of GOP games in Congress), companies who take away existing benefits are losing one factor in employee loyalty. Eventually, when everyone can afford, either on their own or with a little help, to buy individual health insurance, the risk pool will be healthier, far fewer “ER regulars” who do not have means to get regular doctor visits will be driving up costs for everyone, and preventive measures will reduce the number of expensive illnesses in the future, and employees will no longer be tied to their employers as a source of health insurance.

      • empiremed says:

        Despite a continuous and steady repetition of false claims by supporters of Obamacare in and out of Congress, the $716 billion in “savings” from Medicare are taken out of the program to pay for new spending in Obamacare. The cuts do not strengthen the Medicare program, nor do they extend the life of the Part A trust fund. In correspondence with Senator Jeff Sessions (R–AL), ranking member of the Senate Budget Committee, the CBO has confirmed that the majority of the savings leave Medicare to fund Obamacare and thus cannot be counted again as improving Medicare’s finances.

        But Don’t Seniors Get New Drug Benefits?

        Obamacare does spend some money to fill in the coverage gap in the Medicare prescription drug benefit, known as the donut hole, but this is separate from the $716 billion in cuts.

        Although it is typically left out of liberal talking points, beneficiaries will share the cost burden of filling the “donut hole” with the government. According to CBO’s 2010 estimate, “enacting those changes would lead to an average increase in premiums for Part D beneficiaries of about 4 percent in 2011, rising to about 9 percent in 2019.”

        As the average premiums of all Part D beneficiaries increase, keep in mind that in 2007, only 14 percent of those beneficiaries actually fell into the donut hole.

        Moreover, as Forbes columnist and health policy specialist Avik Roy has pointed out, the ratio of cuts to increased benefits is 15 to 1, hardly a good deal for seniors.

        Will the Cuts Affect Seniors’ Benefits?

        Absolutely, without a shadow of a doubt, seniors will feel the impact of Obamacare’s cuts through decreased benefits or the inability to access health care. Heritage expert Bob Moffit has clarified, “Financing directly affects the quantity and quality of the benefits available to the beneficiaries.”

        For example, the Medicare actuary projects that the cuts to Medicare Advantage ($156 billion over 10 years), the popular private alternative to traditional Medicare, where 27 percent of all beneficiaries are enrolled, will decrease enrollment by 50 percent by 2017. Millions of seniors will be forced to give up their current plans and go into traditional Medicare, where they will receive fewer benefits and pay higher out-of-pocket costs.

        Further, seniors will face greater barriers when attempting to access care. The Medicare actuary projects that over the next 10 years, Medicare Part A providers (i.e., hospitals and nursing homes) may stop accepting Medicare patients or 15 percent of them will become unprofitable due to the severe Obamacare cuts. If Obamacare remains on the books, the number of providers becoming unprofitable will reach 40 percent by 2050. A doubling of Medicare patients with a major reduction in the number of providers will guarantee access problems for senior citizens.

        Putting Obamacare’s Cuts in Context

        The Medicare program today is in a desperate situation. The hospital insurance trust fund that finances Part A of Medicare is projected by the Medicare trustees to be bankrupt by 2024. Worse, over the long term, the Administration and Congress have made $37 trillion worth of benefit promises to future seniors that they cannot keep—there simply won’t be funding for them. Despite these enormous issues, Obamacare cuts the program instead of reforming it to last for future generations.

        During tonight’s debate, remember that financing Medicare benefits and seniors’ ability to access those benefits are distinctly correlated. You can’t get something for nothing or a lot for a little. Not on planet Earth.

    • One of the unstated reasons for Obamacare is that employers have been shedding benefits such as pensions, healthcare coverage, and sick leave for years to reduce operating costs and meet shareholder expectations. Without Obamacare, most Americans would be without insurance coverage, or force to pay astronomical COBRA premiums, in less than a decade.
      Employers are not ending their healthcare plans because Obamacare, they are doing it for the same reason they are hiring part time workers instead of full timers: to reduce expenses and increase profits.

    • RobertCHastings says:

      SinceI retired three years ago and got on Medicare, my medical care has improved. Two years ago I had triple by pass surgery and haven’t had to pay a penny. Has this occurred while I was laid off and on COBRA, Iwould have probably had to declare bankruptcy, and the company who HAD previously employed would have never hired me back. Obama’s plan to cover 65% of COBRA saved my ass, too. So, you idiots who bitch about about the high costs affiliated with Obamacare are doing nothing but echoing your dumbass gods like Rush Limbaugh and Glen Beck. Blow it out your f…ing ass!

      • empiremed says:

        Your post is confusing. Are you saying Obamacare saved your ass, or are you saying it would have saved your ass?

    • charleo1 says:

      Look, a great deal of the things you’re blaming on ACA, were already
      happening. Fewer employers were offering health plans. The number
      of uninsured had ballooned to 50 million, in the deep recession. Public
      hospitals were closing their doors, and whether people want to admit it,
      we had a public health crisis on our hands. In some States, families of
      four, were paying $15,000 dollars annually, for health insurance. Then,
      if they were to get seriously sick, or injured, and unable to work, they
      lost the coverage, and the hospital bills still took their home, and savings.
      You want your kids to live in a Country like that? Boy, I sure don’t. Half
      the politicians in Washington, from the way they talk, one would think it
      was taxes that cost people their homes, and savings. Well, it’s not. The
      number one reason for personal bankruptcy is healthcare bills, people
      can’t pay. I’m one of those small businesses they keep praising. And,
      how they are really serious about helping me out, and all. My insurance
      has increased 450% in the last 10 years. And Co-Pays are up all around.
      If I was you, I would open my mind, and quit looking to see what Heritage
      thinks. If they think it’s wrong, they thought it was right, when they proposed
      the very idea of increasing the number of insureds solutions, now being implemented in ACA. Right down to the employers opting out of company
      group plans. And, having employees obtain their health insurance thru exchanges. Now, a lot of us may conclude it could have been done another
      way. Or, we should have done it later. Or, that it’s just better for a democracy
      to have those without the money to pay, either get well, or die. Rather than
      have the government involved. That may be your opinion. But, wait until you,
      or one of your kids get seriously sick, and see how you feel about it.

      • empiremed says:

        Remember that repetitive presidential promise to “cut the cost of a typical family’s premium by up to $2,500 a year”? As 2014 and full implementation of Obamacare get closer, it is crystal clear that won’t be the case.

        Obamacare’s most onerous insurance regulations will directly cause insurance premiums to skyrocket, particularly in the individual and small group markets.

        While there are many provisions that will increase premiums, two will have the most expensive impact:

        Age rating restrictions. Obamacare limits variation in premium costs to a ratio of 3 to 1 based on age. But as Heritage research shows, “The natural variation by age in medical costs is about 5 to 1—meaning that the oldest group of (non-Medicare) adults normally consumes about five times as much medical care as the youngest group.” This means that under Obamacare, young adults will pay significantly higher premiums than they would have prior to Obamacare, and older adults will pay only slightly lower premiums.

        New benefit mandates and cost-sharing rules. Heritage expert Ed Haislmaier explains, “The new law adds a number of health care services that insurers must cover and in some cases restricts the ability of insurers and employer self-insured health plans to impose limits on the amount of services patients can consume. This combination will drive up health plan costs and premiums for both individual insurance and employer-group coverage.” In addition, Obamacare prohibits cost sharing on many preventative services, which will dramatically increase utilization of those services—pushing premiums even higher.

        There have been many different studies done over the past few years to model what premium increases are likely to be under Obamacare’s new rules. The majority staff of the House Energy and Commerce Committee worked with two Senate committee staffs to compile over 30 of them to make a list of projected premium increases by state:

        Source: “The Price of Obamacare’s Broken Promises,” report by the House Committee on Energy and Commerce Majority Staff, Senate Committee on Finance Minority Staff, and Senate Committee on Health, Education, Labor & Pensions Minority Staff, March 2013.

        Many Obamacare advocates attempt to refute these premium increases by pointing to Obamacare’s generous subsidy scheme. But as the Hoover Institution’s Daniel Kessler points out, “This argument is misleading. It fails to consider that the money for the subsidies has to come from somewhere. Although debt-financed transfer payments may make insurance look cheaper, they do not change its true social cost.”

        To that end, Obamacare’s exchange subsidies are estimated by the Congressional Budget Office to cost over $1.2 trillion over 10 years. And nobody should be surprised that this is an increase over the initial (2010) projected costs for these subsidies.

        With the bulk of the health care law kicking in 2014, this is likely just the beginning of Obamacare’s broken promises.

        • charleo1 says:

          How about, before we get all in the weeds, we acknowledge
          a couple of foundational truths, that made healthcare reform
          necessary in the first place. First, the system by which a for
          profit insurance co. charges premiums based not only on
          the cost of the insured’s potential liabilities, but the costs of
          reimbursing providers for an ever growing, non-insured,
          and indigent population, baked right into the cake. Pushing
          premiums upward, which puts more people on the roles of
          the uninsured. Which results in another round of higher premiums.
          As this group, or that, takes one provision, or another, then
          guesses as to what the extrapolated cost of an annual physical
          exam would be. But, failing to take into consideration the
          savings realized when a chronic condition is discovered and
          treated, before it worsens, and creates a huge hospital bill.
          Also, I see none of these groups predicting ever higher costs,

          mentioning the ACA requirement that 80% of premiums must be
          spent on the provision of healthcare. Not advertising, nor increased
          salaries, or dividend payouts to stockholders. The second
          foundational truth, is we are all paying for healthcare now.
          In the most expensive way possible. And, to hold that market
          expansion of healthcare will result in higher premiums, is
          contrary to free market tenants. Which holds that a greater
          volume of sales, decreases the unit price, not increases it.

          • empiremed says:

            The Federal Reserve Beige Book, released on March 6, cited Obamacare as a factor in slowing hiring and employment growth.

            The Beige Book is a report published eight times a year that details the economic activity in the 12 different Federal Reserve regions. As this most recent report explains, “Employers in several Districts cited the unknown effects of the Affordable Care Act as reasons for planned layoffs and reluctance to hire more staff.”

            But why is this news now? Federal Reserve presidents have cited Obamacare as a hiring hindrance for a few years now. In 2010, the Federal Reserve Bank president of Atlanta said, “We have frequently heard strong comments to the effect of ‘My company won’t hire a single additional worker until we know what health insurance costs are going to be.’” There is little more clarity on what the new costs are going to be for business owners. This is why three different Federal Reserve regions have directly linked Obamacare to slower hiring.

            Obamacare imposes new costs and restrictions on business owners. It can be no surprise that many of these owners—particularly smaller companies—have decided to delay expansion and new hires. Regrettably, the harmful impact of Obamacare on the labor market is only going to increase. As many of the provisions, particularly the employer mandates, become closer to reality, more employers are going to alter hiring practices because Obamacare makes hiring a more expensive proposition.

            Join us or watch Monday, March 11, at noon for a Heritage event on this very topic: “Part-Time America.” Heritage analysts, a small business expert, and a small business owner will discuss how Obamacare has impacted the labor market. As the March Beige Book reports, the labor market will continue to struggle due to the costs of Obamacare.

          • charleo1 says:

            Just wondering if these Federal Reserve Presidents thought
            banks leveraging their assets on a 40 to 1 basis, on mortgage
            backed securities, would be the job killer it turned out to be?
            The truth about hiring, is employers hire, when the volume of
            their business dictates it. One reason we have a health crisis
            in this Country, is the very unwise entanglement of a person’s
            access to healthcare, depending on whether the boss feels
            he needs to offer it to retain employees. They may say, well,
            it used to be up to me, if I wanted to offer a health plan. If not,
            I could always depend on the government programs to insure
            my employees. Now, they make me kick in, whether I want to
            or not. As the Heritage Foundation said when they proposed
            this very approach to expanding the number of insured. It’s
            time for everyone to take some responsibility for their own
            healthcare needs. And this plan does just that, by requiring
            everyone who is able to afford health insurance, to buy it.
            And stop depending on others to pay their bills. So, I don’t
            know. But that sounds pretty Republican to me.

          • empiremed says:

            The federal government’s finances were dismal even before the Patient Protection and Affordable Care Act (PPACA) was enacted. That is why lawmakers who pushed for its passage felt compelled to try to calm worried Americans by claiming that the law would cut projected federal budget deficits in addition to covering the uninsured.[1]

            And, in fact, the Congressional Budget Office’s (CBO) official estimate shows that PPACA’s health care provisions[2] would cut projected deficits by $124 billion over the period from 2010 to 2019.[3] But that cost estimate is not the whole story—not by a long shot. A close examination of what CBO said, as well as other evidence, makes it clear that the deficit reduction associated with PPACA is based on budget gimmicks, sleights of hand, accounting tricks, and completely implausible assumptions. A more honest accounting reveals the new law as a trillion-dollar budget buster.


            CBO must assume that current law will be enacted as written, even in cases where this is improbable. For instance, PPACA makes $575 billion in projected cuts to Medicare, threatening seniors’ access to care.[4] Regarding these and the existing planned cuts in payments to physicians under what is known as the “sustainable growth rate” formula, CBO Director Douglas Elmendorf wrote:

            [C]urrent law now includes a number of policies that might be difficult to sustain over a long period of time. For example, PPACA and the Reconciliation Act reduced payments to many Medicare providers relative to what the government would have paid under prior law. On the basis of those cuts in payment rates and the existing “sustainable growth rate” [SGR] mechanism that governs Medicare’s payments to physicians, CBO projects that Medicare spending (per beneficiary, adjusted for overall inflation) will increase significantly more slowly during the next two decades than it has increased during the past two decades. If those provisions would have subsequently been modified or implemented incompletely, then the budgetary effects of repealing PPACA and the relevant provisions of the Reconciliation Act could be quite different—but CBO cannot forecast future changes in law or assume such changes in its estimates.[5]

            Medicare’s Chief Actuary echoed this concern in his own analysis.[6] If Medicare savings do not materialize, new spending under PPACA will be added to the deficit.

            As noted by Elmendorf, Medicare’s payments to physicians are scheduled to be cut as well under the SGR formula. There is bipartisan agreement to stop this from happening. But the “doc fix” costs billions, requiring Congress to scramble to find an offset. Without it, physicians would face a 25 percent (and growing) Medicare payment reduction, restricting seniors’ access to care as more doctors become unable to serve Medicare patients. Congress has never allowed this to happen, even as it has insisted on paying for the “fix” with offsets.

            While pushing PPACA through Congress, President Obama took the position that it was no longer necessary to pay for the “doc fix.” He proposed to add its costs to the national debt, but he did not want those costs to count against PPACA, because they would explode the myth of deficit reduction. So his solution was to pass the “doc fix” in separate legislation. But it does not matter to taxpayers if the President’s ideas are passed in one bill or many. All that matters is the total cost. And the President’s total bill for health care—with an unfinanced “doc fix”—shows massive deficits, not deficit reduction.

            CBO further assumes that all cuts to existing programs and new revenues created by PPACA are used to pay for new spending. In reality, this will not be the case. PPACA increases Medicare taxes and imposes cuts in Medicare that are double-counted as offsets for new programs, but are also pledged to extend Medicare’s solvency.[7] They cannot do both.

            Another source of double-counted savings is the CLASS Act, which creates a new, federally run long-term care insurance program. Beneficiaries will begin paying premiums in 2011 but will not receive benefits for five years. This frontloads revenue and creates the illusion of $70 billion to pay for new spending under PPACA. In reality, premium payments from CLASS will be used to pay out benefits in later years.[8] Senator Kent Conrad (D–ND) called this “a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of.”[9]

            Savings within Medicare and CLASS revenues can be spent only once. If they are used to increase Medicare’s solvency and pay for the CLASS program, new spending in PPACA will be added to the deficit.

            PPACA also creates a new subsidy program for low- and middle-income Americans to purchase insurance in the new health exchanges. CBO predicts that 19 million Americans will benefit from this generous new entitlement program at a cost of $460 billion by 2019. But the new law includes substantial incentives for employers to drop existing coverage and allow employees to instead purchase taxpayer-subsidized coverage.[10] Former CBO director Douglas Holtz-Eakin points out that many businesses could drop their employee health plan, raise wages to make up for the lost benefit, pay the employer penalty for not offering insurance, and still come out ahead.[11] These incentives, exacerbated by the various new insurance rules that will cause a faster rate of growth in employer plan premiums, will cause the cost of the subsidy program to greatly exceed initial projections.

            Finally, the CBO scoring of PPACA looks only at the first 10 years of the law’s enactment. This, however, includes just six years of full spending, as the costliest provisions do not go into effect until 2014. This also allows PPACA to meet the requirements of the pay-as-you-go (PAYGO) rule, which requires legislation to exhibit deficit neutrality over a 10-year window. In theory, PAYGO should maintain levels of deficit spending. In actuality, it has had little success at halting the addition of new spending to the deficit, since new programs can create savings in one decade but run trillions in deficits the next and still meet PAYGO requirements.

            The CLASS program alone is an excellent example of how easy it is to create a new and completely insolvent program without violating PAYGO. Experts—including the CBO Director, Medicare’s Chief Actuary, and the American Academy of Actuaries—have all concluded that CLASS is unsustainable and will go bankrupt. Despite this, Heritage budget expert Brian Riedl writes that, perversely, “repealing CLASS would violate the ‘pay as you go’ law against expanding budget deficits. This is because ‘pay-go’ focuses only on the 10-year $70 billion ‘cost’ of repeal and ignores the trillions of dollars that would be saved thereafter.”[12]

            The reality is that the new health care law will result in trillions in unaffordable deficit spending.


            It Will Increase the Federal Deficit. In 2010, the federal deficit was $1.3 trillion. While the average historical deficit is 2.9 percent of gross domestic product (GDP), by 2050, the budget gap is projected to exceed 20 percent of GDP.[13] This trend is set to continue as the population ages and the baby boomer generation retires, causing the cost of programs such as Medicare, Medicaid, and Social Security to soar.

            Rising health care costs further add to growth in entitlement spending. Creating a new entitlement program and expanding an existing one will hasten the arrival of inevitable financial collapse.[14] The deficit-reducing provisions of PPACA are either unrealistic or unsustainable.

            It Delays Progress to Repair Existing Unsustainable Entitlement Programs. Claims that the new health care law will reduce the deficit are irresponsible and delay meaningful action. To truly reduce deficit spending, Medicare, Medicaid, and Social Security must be reformed. The sooner a solution is adopted, the better: current beneficiaries would experience greater stability and future beneficiaries would have more time to adjust to change.

            PPACA made significant cuts to Medicare, but these can either increase the program’s solvency or pay for new spending—not both. Moreover, the new law increased Medicare payroll taxes and extended them to apply to investment income, but it will use the additional revenue to pay for non-Medicare spending. This sets a dangerous precedent that could further increase the insolvency of the program. The provisions create the illusion of Medicare reform, but the changes are the wrong ones and will only give lawmakers another excuse to further avoid addressing the long-term health of entitlement programs.

            It Promises Future Increases in Taxes and Penalties. As mentioned earlier, PPACA creates enormous incentives for certain employers to drop their employer-sponsored coverage. The employer penalty included in the law ($2,000 per employee) is low enough to allow employers to drop coverage, pay the penalty, and come out ahead. John C. Goodman, President of the National Center for Policy Analysis, writes, “As more employers dump their employees onto the exchange and as the cost to taxpayers rises, the potential pressure to increase the fine will become inexorable.”[15] Larger penalties would harm businesses’ ability to create jobs, raise wages, or keep their current workers.

            It Puts Future Generations on the Hook. Once Americans rely on the new subsidies in order to afford coverage, Congress will have a hard time walking back the generous program. To pay for it, Congress can either raise taxes or add to the deficit. Of course, deficit spending is not free; it merely delays paying for programs, requiring tomorrow’s taxpayers—currently unable to vote—to pay for current citizens’ benefits.[16]

            A New Direction

            If Congress is serious about reducing the deficit and controlling spending, lawmakers should set aside easily manipulated rules like PAYGO and require scoring that reveals the true long-term impact of legislation. This would make it more difficult for legislation like PPACA, which increases the size of government and creates unsustainable new spending, to become law. To reduce the deficit, PPACA must be repealed.

            Budget process reform should enforce policy changes that reduce the size of the federal government, reduce out-of-control federal spending, and prohibit any tax increase on the American people.[17] Congress should prominently disclose long-term entitlement program obligations in the budget resolution to provide a more accurate picture of the federal government’s commitments. Scoring of policy changes should also look at long-term effects on the government’s total unfunded obligations to give lawmakers a more accurate understanding of the true cost of any piece of legislation. In so doing, the reality of PPACA’s 10-year scoring would have been revealed.

            Congress should also establish mechanisms to equitably assess and enforce changes in spending and revenues. CBO’s current spending baseline assumes that laws that authorize spending will continue despite scheduled expiration dates. However, CBO assumes that laws relating to taxes will expire as scheduled. A new enforcement strategy must consider both spending and revenue on the same baseline in order to be effective.

            Finally, mandatory spending on entitlements should be put on a long-term budget. Entitlement spending is currently on autopilot, allowing open-ended growth. Left unchecked, entitlement spending will eventually crowd-out other priorities. Instead, these programs should be put on a limited budget, and Congress should regularly examine their spending and take steps to keep the programs within their limits. Automatic adjustments or triggers should be put in place to reduce spending if Congress fails to act. This will force lawmakers to put these programs on stable financial footing. Medicare should be transformed to a limited, defined-contribution system that allows seniors to seek better value by purchasing a health care plan that suits their needs in the private market.[18] Medicaid reform should limit taxpayer funding but give states greater flexibility to administer their respective programs while also creating the opportunity for beneficiaries to receive better quality coverage in the private market.

          • charleo1 says:

            Well, I can see you’re very concerned about the money. As in,
            there isn’t enough. Let me ask you. What would you think of
            a Country that spent 3X the amount on healthcare than any
            industrialized Country in the world. But, can’t see to it, all it’s
            citizens had proper, and adequate medical care? I’d say that
            is a Government that A. Don’t care about it’s people. Or, B. a
            government that needs to adjust it’s core principals, and
            priorities. Because, at the end of the day, money is like time.
            No matter how busy one is, they will always find the time for
            the things they see as important. And so it is with the budget.
            Some people labor under the illusion that dealing with our
            healthcare crisis is optional. That, all we need to do, is address
            frivolous lawsuits, and let all the insurers congregate in the
            State with the least regulations, and let the Market take care of
            the rest. That, hey! The same market that refuses to cover a
            diabetic, in his 30s, will find a wonderful plan for him at 75.
            They say this with a straight face, and I know they don’t give a
            damn, if he can retain access to a doctor, or not. Or, if he dies.
            And his medical bill, leaves his widow, homeless, and destitute.
            I’m really not interested in excuses from people like this.
            If they don’t want to fix it, they need to get out of the way of
            those that do.

          • empiremed says:

            The Patient Protection and Affordable Care Act (PPACA)[1] contains several provisions that weaken longstanding federal policy denying public subsidies for elective abortion and health care plans that provide coverage of elective abortion. In addition, PPACA fails to adequately protect the conscience rights of health care insurers, providers, and personnel who decline to provide, pay for, provide coverage of, or refer for abortions.[2]

            These defects in PPACA not only fail to fix the patchwork of laws that have been passed to bar federal support for elective abortion; they also create new avenues for federal subsidies and promotion of elective abortion.


            PPACA includes at least three problematic provisions with respect to the federal role in funding elective abortion.[1]

            First, Section 1303 facilitates massive federal subsidies for private health care plans that are offered through health insurance exchanges and will cover elective abortions. Under separate law—specifically, the Hyde Amendment to the annual Labor–Health and Human Services (HHS) spending bill—federal funds appropriated to HHS by Congress cannot be spent for health benefits coverage that includes elective abortion. Section 1303 bypasses this limitation.

            Second, Section 1101 allows the Secretary of HHS to decide whether certain appropriated funds that are not covered by the Hyde Amendment will be used to subsidize elective abortions through temporary high-risk insurance pools. While HHS has announced its intention not to allow such subsidies, the decision is subject to reversal unless there is further action by Congress to block it permanently. Moreover, the Obama Administration has explicitly stated that this discretionary limitation should not be regarded as “precedent”[2] for future executive branch decisions regarding coverage of elective abortion.

            Third, Section 10503 directly appropriated $11 billion over five years to underwrite the operation and construction of community health centers under Section 330 of the Public Health Service Act. Because these funds are not appropriated in the annual Labor–HHS spending bill and are therefore not subject to the Hyde Amendment, their potential use for grants that pay for elective abortions is also a matter of executive branch discretion. President Barack Obama issued Executive Order 13535 in an effort to assure that the Hyde Amendment will be applied to this new community health center funding.[3] As is the case with federal funds for high-risk insurance pools, unless Congress acts to make the application permanent, this decision is subject to reversal by either executive decision or judicial intervention.

            Section 1303 of PPACA also includes language that provides only limited protection for the conscience rights of health care providers and facilities that are unwilling to participate in abortions. Language that was included in the version of the bill adopted by the House of Representatives in November 2009 that would have protected the conscience rights of health care entities and personnel from infringement by government at all levels was omitted from PPACA as finally adopted.


            As a result of these defects in PPACA, longstanding federal policy to provide health care assistance to the poor that favors maternity care over elective abortion has been subverted in several ways, with both short-term and long-term consequences.

            Federal Assistance for Elective Abortions. For the first time ever, a federal tax credit will be made available to assist in the purchase of private health plans that cover elective abortion. By 2019, according to the Congressional Research Service,[4] an estimated 19 million Americans will use these “affordability credits” to buy insurance through the new state health insurance exchanges mandated by the bill. Unless a state has adopted new legislation by that date, taxpayer dollars will flow via these credits to health insurers who pay for elective abortion procedures.

            Limited and Loose Conscience Protections. Even as it expands public subsidies for elective abortion, PPACA provides conscience protections for health care providers and personnel that are both limited in scope and lacking in enforcement guarantees. On July 1, 2010, the American Civil Liberties Union (ACLU) sent a letter[5] to the Centers for Medicare and Medicaid Services urging investigation of Catholic hospitals that refuse to perform and refer for abortions that the ACLU asserts must be provided under federal law.

            One of the laws cited by the ACLU, the Emergency Medical Treatment and Active Labor Act, involves emergency medical services. Section 1303(d) of PPACA references this law and underscores that health care providers are bound by federal and state requirements to provide “emergency services,” potentially including abortions to which religious providers object.

            Inadequate Guidance on Conscience Protections. At the same time, existing federal laws that provide limited conscience protections regarding abortion operate with no clear guidance. In December 2008, the Bush Administration published regulations designed to enforce existing conscience laws by permitting the withholding of federal funds from any state or local government or health care entity that refuses to accommodate the moral convictions or religious beliefs of health care insurers, providers, or personnel regarding abortion. The Obama Administration suspended these regulations in March 2009.[6]

            Several provisions of PPACA compound the problem. Section 1303(c)(1), for example, omits state conscience protection laws from the categories of abortion law protected from federal preemption.

            A New Direction

            The new Congress should enact permanent and comprehensive conscience protections and replace the current patchwork of federal statutes and annual abortion riders on spending bills with a permanent, government-wide policy. The No Taxpayer Funding for Abortion Act (H.R. 5939), introduced by Representatives Chris Smith (R–NJ) and Daniel Lipinski (D–IL) in the 111th Congress, would assure that “no funds authorized or appropriated by federal law, and none of the funds in any trust fund to which funds are authorized or appropriated by federal law, shall be expended for any abortion”[7] outside the scope of the current Hyde Amendment. By applying conscience protection language to all agencies and programs run by the federal government or by states and localities using federal funds, it would protect both individuals and institutions from any discriminatory act because of their refusal to provide, pay for, provide coverage of, or refer for abortion.

            Taking these steps would not only address the abortion funding problems inherent in PPACA but also make longstanding federal policy permanent and avoid debate after debate on this issue in such areas as health care reform, foreign assistance, and defense spending.

          • Sand_Cat says:

            You’re wasting your time. Even this clown’s name is a “healthcare” company. He has an “answer” for everything.

  4. itsfun says:

    How many full time workers will be downgraded to part time workers because of this “health plan”? medicare is being cut in half to pay for the plan. Hospitals will be laying off nurses because “health plan” will not pay enough to hospitals. My cost for medicare goes up over $100 per month also. Don’t you just love how our transparent government passed this bill. Bribes are a normal part of this administration. If I get called to jury duty for a bribery trial, I will be forced to say not guilty, because I feel the Obama administration has make bribery legal.

    • It is unfortunate that greedy private bosses are causing pain for their workers now, but they are also giving up a means of promoting employee loyalty. To be clear, Medicare is NOT saving money by denying benefits; it is saving money by reducing costs of providing the benefits. So, if the government pays, for example, $5000 for one Medicare enrollee today, and next year pays $4000 for care that WOULD have cost $6000 this year, they are actually INCREASING benefits (more CARE) while saving money at the same time. The method that Republicans have proposed to save the SAME amount, on the other hand, actually WOULD cut benefits.

      Bribes in the form of campaign contributions (and extortion in the form of withholding those contributions, or threatening to use them to fund a future opponent) were illegal (though hard to catch) because of laws such as McCain-Feingold, but are now legal because of Citizens United, thanks to the Republican-appointed and openly conservative-biased Supreme Court majority (the Gang of Five? or at least the Gang of Four and a Half?). Candidates of both parties have no choice but to accept this kind of bribe, but as this last campaign showed, Republicans have used Citizens United rights much less honorably in intent than Democrats.

      As far as “bribes” affecting the details of Obamacare, remember that Obama campaigned on a public option to compete with private companies, but found out there were not enough votes to pass that; in the negotiations to get it passed, he was forced by Republicans and some conservative Democrats (who lived in red states and feared primary opponents funded by the aforementioned Citizens United cash; justifiably, as the 2010 midterms proved) to gut the best parts in order to get SOMETHING passed that would BEGIN to solve the problem. And common sense thinking AHEAD shows that, in the long run, it should do so.

      People who are “ER regulars” now will have their own insurance, and even with the subsidy, will cost taxpayers and insured people much less than they do now. Doctors will be encouraged to keep their regular patients healthy by teaching prevention, rather than being paid “by the repair job”. And healthier people will reduce the average risk in the insurance pools, also reducing premiums, even with chronic-disease patients included (excluding them just forced them to become “ER regulars” or go untreated until they landed in the ER … or the morgue; 26,000 people a year die of untreated chronic diseases because they could not get medical help to manage, or even diagnose, these diseases early).

      Incidentally, the new law provides SMALL businesses both exchanges and subsidies that should reduce or eliminate the need to make “all workers part time” and actually REWARD companies that refuse the temptation to do so. The companies that are complaining and threatening are run by people who want to “punish” the President for being re-elected by punishing their workers for voting for him (like the CEO who shut down his company to punish his workers for re-electing the President).

      • itsfun says:

        I don’t care which party is responsible for bribes. I am saying that bribes are not honorable in any way, shape or form. Bribes should not be allowed in any government or business in the US. Now there is no way I would ever convict a person of bribery, because our government allows it.
        If the supreme court is so bias, how did Obamacare get approved by the court? Plus Obama campaigned on a “transparent administration”. What was transparent about bribes made behind closed doors? This health care plan is nothing less than a tax on people that allready pay for their own insuranse and may be forced into a lesser care plan by the government. Why do you think they have death panels. Also I have allready been told by our wonderful government that my medicare payments will be going up $100 a month in 2014. I have no say in this. I will get less care and benifits from medicare after the raise in my rates.

  5. lana ward says:

    The mandate at the heart of Ocare is actually A TAX on the middle class. His promise not to tax the middle class was a deception at the vey heart of his healthcare law. His $264 billion tax tsunami hits this year. Dr. shortages will begin. Ocare could increase premiums 200%–it is designed to fall as a setup for complete Gov. takeover of industry, everybodys’ lives. Yeah, we should all be grateful!!!!

    • A tax that can be avoided by purchasing a product that reasonable people should want to have anyway, but only some people can get currently, but the “tax” law helps you pay for it, is not much of a tax. You will not be required to get insurance (which protects your health AND makes the insurance more affordable for those who already pay for it AND reduces the total taxpayer cost to support hospital ER’s) until the subsidy to pay for it is available.

      Doctors who refuse to take people insured by the new law will not get as many patients as those who will take them, since few people can afford “concierge” contracts for medical care, and they are the only people who will go to those doctors. The only way Obamacare “fails” is that it does not go far enough. Philosophically, we no longer believe that fire protection is a commodity to be sold; we have “socialist” taxpayer-funded fire departments. Health care being part of the right to life mentioned in the D of I, perhaps should not be a commodity either,at least the essentials of health care; the “liberty” to die of untreated illness is not really that much liberty, is it?

  6. I would have preferred a Single Payer system, similar to those in many European countries, but I have to admit that my family has already benefitted from Obamacare. One of my grandchildren is disabled and could not get insurance coverage because of the pre-existing condition. He is now covered and is getting the medical care every human being deserves. Obamacare is not perfect, it does not solve all our problems and it does not address all our needs, especially cost control, but it is a step in the right direction and it can be improved as time goes by.
    Hopefully more and more Republicans will see the benefit of a program that relies on for profit insurance companies as opposed to using Emergency Rooms that rely, in part, on Federal government subsidies, contribute to rising medical costs, and do not include preventive medical care.

  7. nobsartist says:

    I read this article and have to ask the question……why are “Democrats” ramming a failed republiCON policy down taxpayers throats? The answer is simple. Democrat traitors like Max Bauchus wrote Obamacare and really need to be kicked out of the party and tarred and feathered.

    Obamacare takes a policy that was ILLEGAL, “for profit health care” and makes it legal. Plus, it forces us to buy something that was illegal.

    Maybe the government will order us all to buy heroin from Afghanistan next. Afterall, we must support Afghanistan just the way we must support another concept that was once “illegal”.

    I just wonder why Dems never fought back against the law passed by raygun “because free market competition will keep health care costs affordable” in 1982 as much as the traitors have fought roe vs. wade.

    Could it be that both parties are actually the same?

    • Democrats were faced with the choice of holding out for a hard line law that could not pass (and even if passed, would be condemned as “socialist” by the GOP), or getting SOMETHING useful passed. And if nothing passed, the voters would have seen no change in the current system. By getting an incomplete law passed, they generated some support not to go BACK; unfortunately, the forces that brainwashed so many into voting to SUPPORT going back in 2010, against their own interest, were not matched by Obamacare supporters actually voting that year, but at least there were enough who got out to vote to re-elect Obama.

      The new law was not “written by” traitors, its original scope was cut back by the GOP and some Democrats who, due to personal beliefs or fear of a challenge from crazy Republicans, had the best parts for the people taken out.

      For profit health care was NEVER illegal; that is part of the problem. Forcing everyone to buy it, while providing subsidies to those who cannot afford it, is a way to get healthier young people (who, it must be noted, COULD suddenly be taken sick as FDR and Stephen Hawking were, by a chronic disease) into the risk pool so that in future years the premiums will go down. Those who CAN afford insurance but choose not to spend the money, as well as those who CANNOT afford it, will be part of the pool.

      As to why Democrats never challenged the 1982 law, as Republicans have fought Roe v Wade: the Democratic party, by nature, is not a fanatical single issue party, and if they had tried to fight it, they would not have had the votes to override a veto by Reagan, who would have used his brainwashing skills to make sure they did not get re-elected.

      The two parties are not the same, but they have some of the same pressures. Democrats basically want to do what is good for the people, and have a broad coalition of voters to appease, who very much want different parts of that puzzle, and will withhold support from their own party’s candidates if their particular issue is not handled to the extent they desire. Republicans basically want to do what will please their big donors, the wealthy, and those who are brainwashed by those big donors either on bogus security issues (NRA and white supremacist militia), or on religious hot button issues (abortion, gay marriage, now even birth control to avoid the need for abortion), or on racial issues (the “N– in the White House is not really an American” crowd). THEIR voters tend to show up and vote AGAINST ANY DEMOCRAT in general elections, and more of them than Democratic voters vote in PRIMARIES, AGAINST REPUBLICANS THAT ARE NOT PURE ENOUGH IDEOLOGICALLY. And both parties are threatened by lobbyists for big money interests, and so would ANY FUTURE THIRD PARTY once it became large enough to become viable.

      The encouraging sign this year is that the Republican party is becoming fragmented into “issue voter clusters” as the Democrats have been since Reconstruction, while the personal magnetism of Obama may lead some single issue Democrats to see the need to keep Republicans out of power, and motivate them to vote accordingly, while some moderately conservative Republican voters will vote against the inevitably wackier-than-ever nominees of their part in Congressional, state and local races.

      • nobsartist says:

        Prior to 1982, “for profit” health care was illegal. raygun signed the bill in 1982 that made it legal. That is why we had the blue care network through out the United States. A non-profit, the republiCONs have sought to destroy since its creation after WW2.

        In the late 50’s facing a long recession, Eisenhower mandated the freeway system and county built and paid for hospitals that required doctors to rent space.

        In 1982, raygun passed his health care bill that mandated that all county owned and operated health care facilities, built with tax payer dollars, sold to the “for profit” health care industry for pennies on the dollar.

        Plus, his bill made “for profit healthcare” legal where prior to that IT WAS ILLEGAL.

        NO Democrats caused any problems with this so they must have been in on it.

        Bachus and the other “blue dog” democrats (whatever the fuck that is) are the traitors that wrote this bill and Obama signed off on it just like Clinton signed off on NAFTA.

        Obama and Clinton are a couple of bull shit artists.

        ANYONE that votes Democrat is a chump or a closet republiCON because that is exactly what Obama and Clinton are.

        The best republiCON presidents we have had since 11.22.1963.

        The “affordable care act” is another example of gutless Dem action and you should brush up on history.

        You should start to realize that it is impossible to defend an indefensible position.

  8. empiremed says:

    The Medicaid expansion is touted by proponents of Obamacare as a “no-brainer.” While it is true that some states may see projected savings, it is erroneous to claim that this experience applies to every state.

    Proponents predict that by expanding Medicaid states will be able to reduce payments to health care providers, such as hospitals, for uncompensated care. As a matter of fact, nationally, the opposite is true:

    40 of 50 states are projected to see increases in costs due to the Medicaid expansion.

    The majority of states see costs exceed savings when the federal match rate is lowered after the first three years. From there, state costs continue to climb, dwarfing any projected savings.

    State savings are concentrated in large states. New York is estimated to see $33 billion in savings, while Massachusetts is estimated to save $6 billion over 10 years. Because of the design of their current programs, these states have a unique opportunity to restructure their programs and transfer significant cost to the federal ledger. (continues below chart)

    Of course, even these savings are highly speculative. They assume that uncompensated care costs actually decrease under a Medicaid expansion. Analysis of other states shows that this is not always the case. In fact, in Maine, uncompensated care continued to grow.

    Furthermore, the assumed reductions in state supplemental payments to providers for uncompensated care are conditional on state lawmakers enacting explicit payment cuts. Depending on policies adopted by state lawmakers, those reductions could be higher or lower—or even zero—if a state does not enact payment cuts.

    As Heritage analyst Ed Haislmaier points out:

    Under Obamacare, it is even more implausible to assume states would be able to cut uncompensated care funding. That’s because any state payment cuts would have to be imposed on top of Obamacare’s federal payment cuts. Obamacare cuts federal Medicaid “Disproportionate Share Hospital” (DSH) funding by $18.1 billion and Medicare DSH funding by $22.1 billion over the years 2014–2020.

    Therefore, Haislmaier predicts, “governors and state legislators should expect their state’s hospitals and clinics to lobby them for more—not less—state funding to replace cuts in federal DSH payments.”

    The Medicaid expansion represents a massive increase in federal and state spending. Although some claim that states could experience savings, it is clear that this is the exception, not the rule. Expanding Medicaid will ultimately cost states in the long run.

  9. montanabill says:

    Five reasons to be grateful:

    1. Higher taxes
    2. Loss of providers and longer wait for care time.
    3. People not being able to keep their current insurance
    4. Loss of jobs or having your job make into a part-time job
    5. Massive trillions more added to national debt.

    Could be worse. The ill-informed are ready to accept a single payer government system.

  10. QEternity says:

    DemocRats passed the HC bill without reading it. It was written by HC lobbyists who bought off the leadership, like every other special interest group buys off CONgress. If you are not happy about HC ‘reform’, talk to Pelosi & Reid.
    But remember, you have to vote on the bills first to find out what’s inside them, right Nancy?

  11. empiremed says:

    A watershed moment in the ongoing disaster of ObamaCare, as Health and Human Services Secretary Kathleen Sebelius finally admits that health insurance premiums are rising because of the President’s health insurance takeover, per the Wall Street Journal:
    Ms. Sebelius’s remarks come weeks before insurers are expected to begin releasing rates for plans that start on Jan. 1, 2014, when key provisions of the health law kick in. Premiums have been a sensitive subject for the Obama administration, which is counting on elements in the health law designed to increase competition among insurers to keep rates in check. The administration has pointed to subsidies that will be available for many lower-income Americans to help them with the cost of coverage.
    The secretary’s remarks are among the first direct statements from federal officials that people who have skimpy health plans right now could face higher premiums for plans that are more generous. She noted that the law requires plans to provide better benefits and treat all customers equally regardless of their medical claims.
    “These folks will be moving into a really fully insured product for the first time, and so there may be a higher cost associated with getting into that market,” she said. “But we feel pretty strongly that with subsidies available to a lot of that population that they are really going to see much better benefit for the money that they’re spending.”
    Ms. Sebelius added that those customers currently pay more for their health care if their plans have high out-of-pocket costs, high deductibles or exclude particular types of coverage, such as mental health treatment. She also said that some men and younger customers could see their rates increase while women and older customers could see their rates drop because the law restricts insurers’ ability to set rates based on age and gender.
    Don’t worry, folks, ObamaCare is blowing premiums through the roof, but there will be subsidies available for lower-income Americans! That means the rest of us will get screwed twice – once when we pay our higher insurance premiums, then again when we pay for all those lovely subsidies.
    On the political front, Obama’s cherished young voters are getting rooked, but luckily they tend to be low-information types who don’t hold him accountable for anything – they keep saying jobs and economic growth are their top concern, but they voted to re-elect him, didn’t they? And Sebelius is doing her best to mitigate political fallout from sticker-shocked young people by keeping that “War on Women” narrative going. Those brutish misogynist ObamaCare opponents just want to repeal the President’s magical program because they want insurance companies to be able to discriminate against women!
    Elsewhere in Human Events:
    Liberal advice to GOP: Surrender now!
    Who killed the New Majority?
    Sebelius also put some effort into attacking a Society of Actuaries study that predicted an average 32 percent increase in the cost of claims paid out by insurance companies, thanks to the new regulations requiring them to cover people with pre-existing conditions. The effect will be felt unevenly by various states, with the “overwhelming majority” on track for “double-digit increases in their individual health insurance markets,” while a few are expected to see cost reductions. Sebelius tried the same tactic of hiding the corresponding increase in premiums by folding them into the immense red inkblot of general federal taxation and spending:
    The Obama administration challenged the design of the study, saying it focused only on one piece of the puzzle and ignored cost relief strategies in the law, such as tax credits to help people afford premiums and special payments to insurers who attract an outsize share of the sick.
    The study also doesn’t take into account the potential price-cutting effect of competition in new state insurance markets that will go live Oct. 1, administration officials said.
    At a White House briefing Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance today is so skimpy it can’t be compared to the comprehensive coverage available under the law. “Some of these folks have very high catastrophic plans that don’t pay for anything unless you get hit by a bus,” she said. “They’re really mortgage protection, not health insurance.”
    Sebelius said the picture on premiums won’t start coming into focus until insurers submit their bids. Those results may not be publicly known until late summer.
    It’s cute when these people pretend to care about the deficit in order to beat tax increases out of us, isn’t it? But when multi-trillion-dollar government programs need even more taxpayer subsidies to function, we’re not supposed to bat an eye. How many “sequesters” will these subsidies be worth over the next decade? Because when the government is asked to spend $80 billion less in the coming year, it’s a world-ending crisis that causes the entire federal system to tremble on the verge of collapse.
    Remember back when Barack Obama was lying through his teeth and promising you could keep your plan, if you liked your plan? Well, his Health and Human Services commissar thinks your skimpy high-catastrophic hit-by-a-bus plan sucks, so it’s dead. Welcome to socialist reality, suckers. Just wait until you find out what other promises won’t be kept, like maybe those promises of huge federal subsidies for state Medicaid expansion.
    There could be even more taxpayer subsidies on the way, because the Financial Times reported on Tuesday that the US Chamber of Commerce is “appealing to the Obama Administration to grant special relief to employers in states that are rejecting federal aid promised under the President’s health reform program.”
    In states that are not expanding Medicaid, employers will have to pay $3,000 for each employee who joins a state exchange programme to buy health insurance.
    In a filing this month, the US Chamber of Commerce urged the administration to exempt employers in those states from the tax penalties.
    In doing so, the chamber pointed to a decision by the Obama administration to exempt poor people in states that do not expand Medicaid from the “individual mandate”, which requires people to get health insurance or face an individual tax penalty. The chamber said the same approach should be used for employers.
    “If an employer penalty is only triggered by a would-be Medicaid eligible employee, that trigger should be exempted or excused,” the Chamber of Commerce said.
    The additional cost to employers in states that do not expand Medicaid has been estimated as $1.3 billion a year. Of course, if Medicaid is expanded, that’s another fleecing for we, the taxpaying sheep. If we’re going to get our pockets picked anyway, subsidizing businesses sounds like it would be cheaper. And that’s what waiving the notorious “individual mandate” or business mandates amounts to, because the purpose of those mandates is to force every American to buy health insurance right away, rather than waiting until they get sick and invoking that “must cover pre-existing conditions” mandate.
    Governor Rick Perry of Texas, which is resisting Medicaid expansion, made this point through a spokeswoman: “This is not free money from the federal government – it’s either being borrowed from China or taken out of taxpayers’ pockets. The state and federal government can’t afford the current Medicaid program as is, and it’s financially irresponsible to continue expanding a program that we know to be broken.”
    Who knew all these mandates would be so expensive? Oh, that’s right: ObamaCare critics, the most thoroughly vindicated group in modern American political history.

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