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Trump’s new plan could force Congress to pass a health care bill

President Donald Trump announced on July 29, 2017, that if Congress doesn’t act soon on health care, he could end federal “BAILOUTS” for insurance companies, which could effectively force Congress to act on health care reform legislation. (Mark Wilson/Getty Images)

 President Donald Trump announced on Saturday that if Congress doesn’t act soon on health care, he could end federal “BAILOUTS” for insurance companies, which could effectively force Congress to act or else put health insurance companies in the difficult position of having to raise rates on people who can’t afford to pay them or to leave Obamacare exchanges entirely.

“After seven years of ‘talking’ Repeal & Replace, the people of our great country are still being forced to live with imploding ObamaCare!” Trump wrote on Twitter.

“If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” Trump continued.

The “BAILOUTS” to insurance companies Trump referred to in his tweet are “cost sharing reduction” payments, which help health insurance companies keep premiums, deductibles and copays lower than they might otherwise be for lower-income Americans.

If Trump were to withhold these funds from health insurance companies, it would likely result in many insurers choosing to leave the Obamacare health insurance exchanges or pass on insurance costs to lower-income people, who likely can’t afford to pay the added costs.

If health insurance companies choose to leave the insurance exchanges, which is the most likely response, it could catalyze the collapse of the Obamacare exchange system, making it more difficult for members of Congress to wait on implementing a repeal and replace bill.

In June, the Centers for Medicare and Medicaid Services updated its county-level projections for Obamacare exchanges in 2018, and it found 1,300 counties, more than 40 percent of all counties, are expected to have only one Obamacare health insurance provider available to consumers, according to a report by CNBC. That means 2.4 million people will be forced to buy health insurance from their one and only option or else pay the Obamacare penalty imposed on those Americans who don’t have qualifying health insurance.

CMS also predicts there will be 49 counties in which consumers will have absolutely no health insurance options on their Obamacare exchange.

“I am deeply concerned about the crisis situation facing the individual market in many states across the nation,” Seema Verma, CMS administrator, said in the report.

In reaction to Trump’s threat, Senate Minority Leader Chuck Schumer (D-N.Y.) said Trump is “playing politics with people’s lives.”

“If the president refuses to make the cost sharing reduction payments, every expert agrees that premiums will go up and health care will be more expensive for millions of Americans,” Schumer said.

“The president ought to stop playing politics with people’s lives and health care, start leading, and finally begin acting presidential,” Schumer added.

f @POTUS refuses to make CSR payments, every expert agrees that premiums will go up & #healthcare will be more expensive for millions.

HEALTH INSURANCE REFORM AND THE AMERICAN ENTREPRENEUR

By John F. Di Leo –

Part One of the House GOP’s official plan to repair/undo/fix/replace Obamacare was released this week, to utter shock and dismay. The authors say that everything America needs will be in the full packet, so it’s unfair to judge Part One without seeing the rest. That may be true, so here, let’s just look at the big picture, whether it’s one part, two parts, three or ten.

America had a healthcare financing problem a decade ago. Conservative solutions, such as malpractice/tort reform, extending the tax-deductibility that employer-provided health insurance gets to individual policies too, and closing the borders to reduce the massive healthcare drain by indigent illegal aliens, were never given a chance. Instead, the Democrats, on straight party votes and through illegal contortions of the lawmaking process, forced through a costly and destructive nationalization of healthcare financing.

As was predicted, it was an utter disaster. Few government programs have ever been so universally hated as Obamacare.

So today – with a Republican majority in the House and Senate, along with a Republican in the White House, American has an opportunity to undo it at last… to both undo the disaster that is Obamacare, and also implement the fixes that we knew were needed all along, but never got the chance to make before.

The Big Picture

But health insurance – and the healthcare financing process in general – is only part of the economic task faced by the new administration. It’s a big part of it, but it still exists within a bigger challenge;

We are trying to climb out of a ten year long recession. Economists don’t like to admit that, because the formal definition is two successive quarters of negative growth, and we’ve only suffered that here and there.

But in fact, when you consider job losses, inflation, general contraction of manufacturing, and the continued growth of the critical employment measure – people of working age outside the workforce” – it is undeniable; the economy has been rotten for a decade. It may not have been a recession to economists, but it’s been a recession to human beings.

For a decade now, the US economy generally produced around 200,000 jobs a month, most of them lousy.

By that, we mean that – unlike past eras of manufacturing growth and general expansion – in this period, too many of the new jobs are dead-end or near dead-end jobs. A starting job on an assembly line may pay poorly at first, but it may lead to a role as team lead, supervisor, manager, foreman, plant manager. A starting job at a coffee shop or retail counter, by comparison, may be a great, convenient part time job for a student, but has far less potential for career growth.

The problem with the Obama economy is that even the tepid number of jobs it did produce included too many of the latter type, and too few of the former.

We desperately need to make up for this ten year disaster.

Since healthcare financing was part of the problem before 2010 – and it became an incredibly bigger part of the problem after passage of Obamacare (the ACA) – fixing this particular mess is clearly a critical first step in delivering the economic boom that the market and the voters are all expecting, and in fact have already baked into their forecasts. We cannot let them down!

We need the U.S. economy to produce 20 million more jobs, including a couple million startups and millions of part time and full time independent consultants, during this presidential term.

… and we need most of the many American manufacturers who have moved production lines overseas during the past 20 years to finally start moving them back.

Somehow, the Obamacare repair/undo/fix/replace project (again, whether it’s one bill or a set of several) needs to do everything it can – and it can do much! – to advance these critical goals.

Has the Congressional leadership looked at it that way? Are they just focusing on reducing the obvious, direct pain of Obamacare as fast as possible? Or are they consciously working to use the Obamacare correction to undo the damage that both the Obamacare era and the pre-Obamacare era have done to our economy?

Job Creation and the Monkey-Wrench

Let’s go back in time, and think about how health insurance costs affected decision making a decade ago, when we thought we had it so bad…

Ten years ago, let’s say you wanted to start your own startup or independent consultancy.

Leaving a job that had insurance to branch out on one’s own, one had to plan on paying $50 to $100 a month for a single policy, or – for a breadwinner – a couple hundred a month for a family policy. Such plans are necessary, to cover basic healthcare needs if something big happened, and ensure decent pricing for normal things (rather than paying “rack rates”).

Such affordable programs (somewhat high copay, somewhat high deductible, but basically fine for most people) are gone now. They’re just GONE. Obamacare has thrown a monkey-wrench into the start-up society.

Thanks to Obamacare – and its laundry lists of mandated coverage, its worthlessly micromanaged exchanges and gold/silver/bronze plans of inflated coverage, that insists on paying for Ralphie to turn into Mabel, and funding abortions for 70 year old women and birth control for nuns – health insurance today is horribly, unbearably overpriced.

We’ve spent seven years rightly talking about what this does to the individual stuck with the plan… but we haven’t talked enough about what it does to the natural urge of the entrepreneurial – the small business minded American minority – to branch out on their own.

The Obamacare era’s outlandish pricing and awful product (in most cases, we pay more than ever for insurance that can’t even be used, because of the high deductibles and lack of providers) have scared Americans out of entrepreneurship.

Obamacare literally traps employed people in their current jobs. Starting up your own business takes considerable energy and courage to begin with; this massive corruption of the healthcare aspect of American life has added a massive weight to the already stiff burden of the American start-up.

People working for big companies, the very people who used to start their own businesses, are now unable to do so, because the insurance costs don’t let them take that additional risk.

And what America needs most of all right now is an influx of new businesses, of courageous new entrepreneurs to rent offices and start inventing and selling and hiring… exactly as entrepreneurs always did in America, before the Obamacare era.

This is what has been forgotten in the recent debate… perhaps because, as usual, small businessmen aren’t heard the way that big businessmen are in our society, and perhaps because the future entrepreneur has no voice, only the past entrepreneur does.

Obamacare – as a whole, not just in the employer mandate, but AS A WHOLE – is utterly destructive to small business. Over the seven years since that hellish March 20 when it was illegally passed and signed, the number of startups has plummeted in Amerca.

We need to terminate Obamacare to get back what we had 8 years ago, to begin with.

It’s a critical first step, not just for fixing healthcare, but for starting the economic boom we so desperately need. But then… we need the corrections – the simple, logical corrections – that we knew were needed at the time, but which the Democrats refused to allow us to do.

For example:

Tort reform, to reduce the cost that malpractice insurance places on health care pricing.
Use of the Commerce Clause to allow insurance companies to sell plans across state lines.
Extend tax-deductibility of health insurance to individually-purchased plans, just as employer-provided insurance is.
Crack down on crime, particularly the drug gang crime of the inner cities and the border jumping practice of tens of millions of illegal aliens, which fill our hospitals with costly patients who can’t pay for their coverage.
This is just a start. There’s more, of course, much more. And they’ve been on the Republican reformers’ drawing boards now for eight years, disallowed from seeing the light of day.

But they are necessary. Because a simple tweak of Obamacare to reduce the most egregious errors isn’t enough. Removing the mandate, dropping a couple of the taxes, but leaving the structure in place would only help a bit on the surface, while leaving the leviathan in place to keep on holding America back from the recovery we so desperately need.

There is a huge barricade in place, retarding the natural American impulse for job creation and economic advancement. And until that barricade is removed, our economy cannot recover.

Copyright 2017 John F. Di Leo

Highlights of House GOP's ObamaCare replacement bill

 

Here are highlights of the legislation unveiled Monday by House Republicans as they move to dismantle former President Barack Obama’s health care law and replace it with a system designed along conservative lines. Primarily affected would be some 20 million people who purchase their own private health plans directly from an insurer and the more than 70 million covered by Medicaid, the federal-state program for low-income people.
Here’s a look at some of the major components:
——
PRIVATE HEALTH INSURANCE
— Provides tax credits for people purchasing their own health insurance. The subsidies would be keyed primarily to age, rising as people get older. Financial assistance would be phased out for individuals making more than $75,000 and married couples earning more than $150,000. Subsidies could be used to buy any plan approved by a state.
— Eliminates cost-sharing subsidies in Obama’s Affordable Care Act that helped people with modest incomes meet the costs of insurance deductibles and copayments. States, however, would have the option of providing similar assistance with federal financing.
— Greatly expands contributions to health savings accounts, which allow people with high-deductible insurance to cover expenses that their plans don’t pay for.
— Protects people with pre-existing health problems from being denied coverage. However, consumers must maintain continuous coverage — otherwise, they would face a flat 30 percent surcharge on top of their premiums. States could use federal money to create high-risk pools as insurers of last resort.
— Preserves ACA provision that let young adults stay on parental coverage until they turn 26.
— Allows insurers to charge their oldest customers up to 5 times what they charge young adults. The ACA limits that to 3 times.
— Prohibits use of tax credits to purchase any plan that covers elective abortions. Currently if a health plan covers abortions it must collect a separate premium to pay for such procedures.
——
MEDICAID
— Maintains the ACA’s higher federal financing for expanded Medicaid through the end of 2019. After that, states can only continue to receive enhanced federal payments for beneficiaries already covered by the expansion, which has mainly helped low-income adults with no children living at home. But for newly enrolled beneficiaries, the federal government would provide a lower level of financing.
— Overhauls the broader Medicaid program to end its open-ended federal financing. Instead, each state would receive a limited amount based on its enrollment and costs. That federal payment would be increased according to a government measure of medical inflation.
— Denies federal funding for one year to Planned Parenthood, a major provider of women’s health services, including abortion.
——
PENALTIES & TAXES
— Repeals the ACA’s tax penalties on people who remain uninsured and on larger employers who do not offer coverage. The repeal is retroactive to 2016.
— Repeals the ACA’s taxes on upper-income earners, investors, health insurance plans and medical device manufacturers. Repeals 10 percent sales tax on indoor tanning.

Woman Who Ran Obamacare Defects, Reveals Obama’s Sick Next Step

The woman who ran Obamacare during her tenure as the administrator of the Centers for Medicare and Medicaid Services, which played a pivotal role in implementing the failed program, claimed last week that health care customers could be in for a huge sticker shock come 2017.

“I’ve been asked, what are the premiums going to look like?” Marilyn Tavenner, who now works as a spokeswoman for insurers, said during an interview with the Morning Consult. “I don’t know, because it also varies by state, market, even within markets.”

She added, “But I think the overall trend is going to be higher than we saw previous years … that’s my big prediction.”
Since its launch in 2013, Obamacare has repeatedly caused premiums, co-payments and deductibles to skyrocket, despite rhetoric from President Barack Obama’s administration about how the law would reduce health care costs for Americans.

Instead, it spurred many Americans to drop out of the program altogether and opt for much more affordable but less comprehensive non-Obamacare alternatives.
In explaining why rates keep rising, Tavenner pointed to a number of factors, including Obamacare’s rules preventing insurers from denying coverage to anyone suffering from a pre-existing condition.

“The problem with the exchanges … is people are still kind of seeing this as, ‘I use insurance when I’m sick, but I may not need it when I’m no longer sick,’” she explained. “So they tend to churn. And that churn increases premiums. So you have to kind of price over that.”

Tavenner also highlighted the upcoming end of certain rules that protected insurers from experiencing financial losses. Without these rules in place, many insurers will need to dramatically raise their premiums just to break even, let alone earn a profit.
President Obama will keep claiming otherwise until his face turns blue, but Obamacare is an epic failure — and clearly, the woman who used to run it pretty much agrees.

Another ObamaCare Dream Goes Bust

A lot of people have to pay back their 2014 ObamaCare Subsidies to the IRS

doc-obama-this-is-gonna-hurt

A lot of people who received subsidies from ObamaCare in 2014 are finding out that the Affordable Care Act is forcing them to pay that money back to the Internal Revenue Service because the administration did a poor job of spreading important information.

When individuals enrolled in the program at the beginning of last year they had to estimate their income for 2014. The amount of the subsidy that the individual would receive was based on this estimate. Some people thought they could get away with receiving higher monthly subsidies if they intentionally estimated a low income for 2014, while many others simply had no idea what their incomes would be.

What many of these people were not aware of was that they were responsible for informing the government if they had an unexpected rise in their incomes that would invalidate their original estimate. If somebody’s income rose past their original estimate and they did not report it, then they would have received a larger subsidy than the law allowed. ObamaCare officials did not make this information well-known, and now people are paying the price for it.

For example, Janice Riddle is a woman from California and couldn’t believe it when she found out she would owe the IRS money. “I was blindsided that the subsidy has to be paid back,” she said. “I’m in shock…but I have no choice. Do I want to argue with the IRS or the Obama administration?” She has to pay back her entire subsidy, which came out to $470 per month.

Her case is not an isolated incident. For example, early data from some taxpayers shows that 53 percent of Jackson Hewitt clients who received subsidies will have to repay part or all of their subsidies–not a trifling sum, since the average monthly subsidy in 2014 was $264. The largest amounts owed in repaid subsidies so far reach as high as $12,000 .

Some of the people whose subsidies have been reduced or lost can no longer afford the full cost of their monthly premiums, so they are choosing to go without health insurance this year. Sadly for these individuals, the individual mandate penalty for being uninsured (which could be as high as $975 per person next year) suddenly looks like a bargain compared to the true cost of ObamaCare’s unaffordable insurance.

Instead of making health insurance more affordable, ObamaCare is merely transferring costs onto taxpayers. When the subsidies are taken away from people, it’s clear that premiums are way more expensive than officials in the government are leading people to believe. It’s an incredibly complicated law and has been impossible to implement without causing headaches and damage for millions of people.

Some Unpleasant Welfare Arithmetic

By Casey B. Mulligan, University of Chicago
Obamacare1211

The Affordable Care Act (ACA) presents employers
and potential employees with a variety of
new rewards and penalties. These are, in part,
exactly what the law intended: by penalizing
potential employees for not purchasing health insurance,
and employers for not providing it, the law aims to increase
the fraction of the population with health insurance.
Yet these same rewards and penalties have additional
effects, including on the incentive to work; Mulligan
(2014), for example, suggests that the ACA may reduce
employment by 3 percent on average and have a range of
positive and negative effects on average hours worked.
In the work summarized here, I quantify the number
of people who will have essentially no short-term financial
reward from working more than 29 hours, since this
would either render them ineligible for the ACA’s assistance
or increase the penalties that may be owed by their
employer. This is the first paper to show that the ACA
will put millions of workers in the economically extreme
situation of having zero short-term financial reward (or
less) to working full-time rather than part-time.
In economics jargon, this means the ACA creates
marginal tax rates on labor income that exceed 100
percent. Even when helping people who are out of work
or who otherwise have low incomes is a primary policy
motivation, and even if labor supply does not respond
much to the after-tax wage, labor income tax rates that
equal or exceed 100 percent are bad policy because they
discourage work effort without raising any revenue.
From a strictly predictive perspective, economists expect
that full- time employment rates will be low, if not zero,
in groups of people who are aware that they receive no
financial reward from working full-time (defined here to
be working at least 30 hours per week).
Two separate ACA provisions can fully eliminate the
reward to full-time work. The first, which is scheduled to
be in full force in 2016, pertains to full-time employees
of firms that do not offer health insurance: by cutting
weekly work hours to 29, they save their employer the
annual salary equivalent of more than $3,000, or, they
save their employers the threat of even larger penalties.
Women workers, young workers, and persons already
working 30–35 hour schedules are especially likely to have
their short-term financial reward to full-time work erased
by the ACA. By my estimates, three to four million workers
overall will fall victim to this penalty provision.
2
The second provision pertains to full-time employees
at firms that do offer health insurance. Over 60 million
workers obtain health insurance from their employer, not
including workers who obtain health insurance from a family
member’s employer. About half of them (26 million) are
in families between 100 and 400 percent of the poverty line
and therefore satisfy the income criteria for exchange subsidies.
And 11 million of those are unmarried—so by definition
cannot be covered by a spouse’s plan—and another 8 million
of the married have a spouse that does not work or otherwise
cannot obtain coverage through a spouse.
In other words, almost 20 million workers are ineligible
for exchange subsidies solely because their employer offers
coverage to full-time employees: these are the workers
subject to the ACA’s implicit full-time employment tax
(FTET). A 29-hour work schedule, on the other hand,
would make them eligible for subsidies without creating
any penalty for the employer.
In about four million cases (of the 20 million facing an
implicit FTET of some magnitude), the dollar amount of
subsidy gain can exceed the after-tax income that is earned
for working beyond 29 hours per week. A distinguishing
feature of almost 90 percent of these workers is that
their family incomes are below 250 percent of the federal
poverty line. The four million disproportionately consist
of working unmarried household heads because, as noted,
unmarried heads are especially likely to be ineligible for
exchange subsidies solely because their employer is offering
coverage to full-time employees.
Older (but not elderly) workers are also disproportionately
represented among those facing an implicit FTET
rate of 100+ percent, since older workers are more likely
to have employer-sponsored insurance and are more
expensive to insure. The 100+ percent FTET from the
employer penalty has the opposite age pattern, which
means there may be little age pattern for the propensity
to face one of the 100+ percent FTETs.
The prevalence of 100+ percent FTETs is an important
indicator of its effects on incentives to work, but it is not
the only one. There are other ways to avoid the FTET, such
as working more hours per week for fewer weeks of the
year. If employers are unwilling or unable to adjust work
schedules, the FTET may affect the equilibrium relationship
between hours and earnings (i.e., compensating differences)
rather than changing the distribution of hours. At
the other extreme, employers may be able to substantially
adjust measured work hours without changing the actual
work that is done (e.g., require employees to “punch out”
during break periods, and then adjust their hourly wage so
that weekly earnings are the same), in which case the ACA
will reduce the measured hours for quite a large number of
workers.
In effect, millions of workers are becoming eligible
for fully federally funded paid days off, akin to the sick
leave policies in Western European countries. Because
the Western European data suggest that paid sick days
really do result in fewer days at work (Lusinyan 2007), we
should expect the act’s FTETs to reduce days worked as
well, at least for the segments of the workforce that do
not avoid the ACA’s taxes in other ways.
These effects of the ACA are only part of its impact;
people who believe government should provide health
insurance for everyone may regard these costs—the
disincentive effects discussed here and elsewhere—as
worth paying.
But everyone should recognize that the ACA’s costs
are likely to exceed the budgetary expenditure.

Beyond Obamacare

Obamacare Real Enrollment: Just 1.7% of Uninsured Covered

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Obamacare, the plan purportedly created to provide health coverage for the uninsured, has enrolled just 1.7% of America’s 48.6 million uninsured.

News of the disastrous numbers comes as nervous Democrats and President Barack Obama, ahead of the November midterm elections, did their best on Monday’s enrollment deadline to put a positive spin on the deeply unpopular Obamacare program. The latest Associated Press poll finds that Obamacare has now hit an all-time low approval rating of just 26 percent.

The White House now claims an Obamacare enrollment figure of six million people. However, according to The New York Times, at least 20% of those never paid their premiums to activate coverage, leaving them uninsured. That drops the number down to 4.8 million.

Next, as Washington Post columnist Ed Rogers notes, “the official HHS numbers still include duplicate enrollments.” No one knows how many duplicate enrollments are in the stack; the White House refuses to say. However, given the disastrous Obamacare website failures, it is reasonable to imagine that the pile is riddled with numerous “false start” applications.
That leaves the most important question: How many people are gaining insurance who were previously uninsured? After all, that was the stated reason for Obamacare in the first place. McKinsey & Co. says that only 27% of those who have picked a plan through Obamacare were previously uninsured.
Moreover, McKinsey says these individuals have an unusually high rate of failing to pay their first month's premium. "Only 53 percent of them had paid their first premium, compared with 86 percent of the previously insured," reports CNBC.
Even conceding the White House its alleged six million enrollment figure (which, again, includes duplicates and incomplete applications), that would mean that just 810,000 of paying Obamacare customers were previously uninsured, a figure that represents 1.7% of America's 48.6 million uninsured people.
Indeed, most of those the White House counts as Obamacare enrollees are among the five million who had their health insurance plans canceled due to Obamacare.
Obamacare has taken a severe toll on President Obama's approval rating. The latest Associated Press poll reveals that his disapproval rating has now hit an all-time high of 59%. As one Democratic member of Congress told The New York Times, Obama is "poisonous" to Democrats running in the November 4th midterm elections.
Americans head to the polls in 218 days.

Another Obamacare Tax That Insurers Are Forced To Pass Along To You

by Ben Bullardobamacare-tax-300x215
An Obamacare tax that will dump money into the general treasury was finalized last week with little fanfare, locking in a Federal revenue stream that, at least in theory, was set in place to cover the gap in “United States health risks” that Obamacare’s regressive, market-defying structure creates.
The Health Insurance Tax was published Nov. 27, mandating a tax on insurance companies that analysts expect will lead to an additional three percent increase in the cost of already-inflated premiums for Obamacare buyers. The goal for 2014 is to hit a Federal revenue target of $8 billion ($14.3 billion by 2018), even though there’s not a set rate at which insurers themselves can anticipate being taxed.
How does that work?
“It’s an odd sort of tax,” Heritage Foundation Fellow David R. Burton told the Washington Free Beacon. “It’s not at a specific rate, but it raises a specific amount of revenue from insurers who underwrite health insurance outside of the exchanges. You basically have a set amount of money and then it’s allocated among the insurers based on the amount of health insurance premiums they actually wrote.”
In other words, the government is gonna get its money without providing insurers a strategic roadmap that affords them any knowledge of how much each company will be forced to contribute. Worse, the government’s dollar goal is fixed, even though Obamacare’s terrible enrollment rate indicates insurers may not even profit from the few policies they’re able to sell.
Those Americans who do buy an Obamacare plan won’t see the tax itemized on their statements. But they’ll be paying it. The New York Business Council has estimated the Health Insurance Tax will cost participating residents an average of $270 in increased premiums for 2014 – the “cheapest” tax year.
The Health Insurance Tax is just one of many Obamacare taxes. Here’s a long list of others, compiled by The Heritage Foundation.

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