Archive for the ‘Obamacare’ Category
One of the most politically intense fights over the Affordable Care Act was over the creation of the Independent Payment Advisory Board, infamously dubbed a “death panel” by Republicans during the 2010 elections.
On Thursday, Republican House Speaker John Boehner and Senate Minority Leader Mitch McConnell signaled that they would keep working to keep opposition alive by doing everything they can to impede the board’s implementation.
The two leaders wrote a letter to President Barack Obama, notifying him that they would not be submitting any recommendations to the panel because of their opposition to it and to the law in general.
Here’s the relevant part of their letter explaining why they aren’t offering any recommendations:
In order to allow supporters to claim that the law’s Medicare cuts would be realized in the future, it tasked IPAB with reducing payments to providers or eliminating payments for certain treatments and procedures altogether. These reduced payments will force providers to stop seeing Medicare patients, the same way an increased number of doctors have stopped taking Medicaid patients. This will lead to access problems, waiting lists and denied care for seniors.
The unfortunate result is that decisions which impact America’s seniors will be made in the absence of the democratic process, without the system of checks and balances that would normally apply to important matters of public policy. Yet your recent budget called for expanding IPAB by tasking it with making even larger cuts to Medicare than those called for in the health law, even though the trustees of the Medicare program have told us that IPAB’s provider cuts would be “difficult to achieve in practice,” because of the denied care that seniors would experience.
Though the move will likely play well for Republicans politically, it won’t have much of an effect on the implementation of the health care law, at least for the foreseeable future, according to health care law professors.
The IPAB is set up to be a 15-member panel. Three members will be chosen by the Republican leaders of the House and Senate, and the remaining three are chosen by Obama and the executive branch. All of the members have to be confirmed by the Senate.
But the IPAB is only needed if Medicare costs are projected to go beyond economic growth plus an additional percentage point in any given year, said Allison Hoffman, an assistant professor of law at UCLA. Right now, Medicare costs aren’t growing fast enough to require the board to decide which cuts to make to Medicare providers.
“There’s actually no work for the IPAB to do this year,” Hoffman told Business Insider.
McConnell and Boehner’s letter has “no impact on the ground,” Hoffman said. “It’s a protest move. You know — we’re not going to cooperate with what the law says in this regard.”
The real name of Obamacare – a name known only to a few policy wonks and politically correct medical students – Patient Protection and Affordable Care Act, or PPACA. With a name like that, who could object to it? Who would be against “patient protection” or “affordable” when it comes to a government-funded program such as Medicare? Really, who would want “unaffordable,” though that’s generally what we get in government spending programs? But what does “Affordable Care” really mean?
Although Obamacare is fluid, being rewritten hourly, as of this moment, the plan is to create “accountable care organizations,” or ACOs. These will be defined by geographic areas that contain a certain number of patients. Currently, for example, a pilot ACO blankets a large area of northwestern Iowa.
You the patient, at first, won’t know that you “belong” to the ACO. But the government has assigned you, if you are a Medicare recipient, to a specific ACO. The ACOs will then be held responsible for quality – as defined by government – and for cost containment.
I recently attended a pie-in-the-sky, rah-rah session given by the CFO of one of the new pilot ACOs. He went into great detail about the good deal awaiting those hospital systems that play the game well. The details, as he admitted, are somewhat lacking, as the rules continue to be written. But I got the big picture. The big picture is: This is a three-step shell game to bring about the death of private practice medicine in America.
Here is how it will work.
Step one: America will be sliced up geographically into ACOs, which will gather all sorts of patient-care data for the feds and will be paid a fee for service at Medicare rates. The ACOs will be lauded as the saviors of medicine and given bonuses for quality and cost containment. Currently, they are being offered a 50-percent cash rebate for any savings they bring about. Patients can choose to go anywhere for care, in or out of the ACO. Private practitioners outside the system will be “allowed” to keep practicing, they will not be forced to join the ACOs – that would be un-American – but these small practices will be unable to survive the regulatory burden of Obamacare. So, these doctors will retire early, or close up shop or simply go to work for the ACOs, where they will do better financially.
Step two: Once private practitioners are squeezed out of existence, there will be no competition. The ACOs will be the only show in town and totally under the thumb of the federal government. At this point, the bonus money will go away, and the feds will squeeze down payment to doctors and hospitals. (The CFO who spoke at our meeting may think the federal government is willing to leave free money on the table for him to pick up, but that only is doled out to favored political donors, not to producers. The bonus is simply another bribe historically given to businesses by government in order to make them vassals of the state … and businesses never seem to learn.) Small hospitals will have to consolidate under big ones or go out of business. At this point, to prepare for the final step, rumblings of problems in the ACOs will start.
Step three: As government reimbursements diminish and there is no private option, the system will fail to deliver adequate care. Patients won’t be able to get appointments or timely surgery, doctors will complain, hospital staffs will strike and in general the system will implode. Government, always ready to leap into the breach (and reminiscent of the precedent of the Reichstag fire), will declare a national crisis and push through emergency legislation – that is already in the system – to nationalize health care. Hospitals will be taken over by the feds, doctors and nurses and all necessary personnel will have no choice but to be government employees, and at this point patients will be assigned to the ACOs without any choice in the matter. At the stroke of a pen health insurance will cease to exist, and perhaps the companies who sold insurance will be placed in charge of administrating these ACOs. (This road is already being paved as big companies like Blue Cross are given government contracts to administer Medicare.)
Think this can’t happen? Even some of the ACO administrators admit they are being set up to fail. But fail to what end? To the goal which has been the goal all along: establish a national health service ala Canada or England or Sweden. This is not a medical or societal evolution; this is programmed incremental revolution, and we – like the Russians and French and Cubans – will pay the price, because when free market medicine goes, so goes freedom. The power that brings about this government takeover will not limit itself to medicine. It will consume every facet of the social and economic life of America.
Libertatem requiescant in pace.
Read more at http://www.wnd.com/2013/05/obamacares-bigger-plan-destroy-and-rescue/#jH4ZMVz5JCOcZzR3.99
The South Carolina state House passed a bill Wednesday that declares President Obama’s Patient Protection and Affordable Care Act to be “null and void,” and criminalizes its implementation.
The state’s Freedom of Health Care Protection Act intends to “prohibit certain individuals from enforcing or attempting to enforce such unconstitutional laws; and to establish criminal penalties and civil liability for violating this article.”
The measure permits the state Attorney General, with reasonable cause, “to restrain by temporary restraining order, temporary injunction, or permanent injunction” any person who is believed to be causing harm to any person or business with the implementation of Obamacare.
Earlier this year in her state of the state address, Gov. Nikki Haley said that South Carolina does not want and cannot afford the president’s plan, “not now, not ever.”
The most destructive Obamacare tax increases are just around the bend
Asked about Senator Max Baucus’s (D-Mont.) recent “train wreck” comments, President Obama today said, “A huge chunk of it [Obamacare] has already been implemented.” Unmentioned was the wave of destructive Obamacare tax increases that will begin to hit Americans during the next tax filing season and beyond:
Starting in tax year 2013:
Obamacare Surtax on Investment Income: A new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This tax hike results in the following top tax rates on investment income:
Capital Gains Dividends Other*
2013+ 23.8% 43.4% 43.4%
*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. (Bill: Reconciliation Act; Page: 87-93)
Obamacare Medicare Payroll Tax Increase:
All Remaining Wages
2.9% self employed
(Bill: PPACA, Reconciliation Act; Page: 2,000-2,003; 87-93)
Obamacare Medical Device Tax: Medical device manufacturers employ 409,000 people in 12,000 plants across the country. Obamacare imposes a new 2.3 percent excise tax on gross sales – even if the company does not earn a profit in a given year. In addition to killing small business jobs and impacting research and development budgets, this will make everything from pacemakers to artificial hips more expensive. (Bill: PPACA; Page: 1,980-1,986)
Obamacare High Medical Bills Tax: Before Obamacare, Americans facing high medical expenses were allowed a deduction to the extent that those expenses exceeded 7.5 percent of adjusted gross income (AGI). Obamacare now imposes a threshold of 10 percent of AGI. Therefore, Obamacare not only makes it more difficult to claim this deduction, it widens the net of taxable income. According to the IRS, 10 million families took advantage of this tax deduction in 2009, the latest year of available data. Almost all are middle class. The average taxpayer claiming this deduction earned just over $53,000 annually. ATR estimates that the average income tax increase for the average family claiming this tax benefit will be $200 – $400 per year. To learn more about this tax, click here. (Bill: PPACA; Page: 1,994-1,995)
Obamacare Flexible Spending Account Tax: The 30 – 35 million Americans who use a pre-tax Flexible Spending Account (FSA) at work to pay for their family’s basic medical needs face a new Obamacare cap of $2,500. This will squeeze $13 billion of tax money from Americans over the next ten years. (Before Obamacare, the accounts were unlimited under federal law, though employers were allowed to set a cap.) Now, a parent looking to sock away extra money to pay for braces will find themselves quickly hitting this new cap, meaning they would have to pony up some or all of the cost with after-tax dollars.
Needless to say, this tax will especially impact middle class families.
There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. Nationwide there are several million families with special needs children and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. This Obamacare tax provision will limit the options available to these families. (Bill: PPACA; Page: 2,388-2,389)
Starting in tax year 2014:
Obamacare Individual Mandate Non-Compliance Tax: Starting in 2014, anyone not buying “qualifying” health insurance – as defined by President Obama’s Department of Health and Human Services — must pay an income surtax to the IRS. The Congressional Budget Office recently estimated that six million American families will be liable for the tax, and as pointed out by the Associated Press: “Most would be in the middle class.”
In addition, 100 percent of Americans filing a tax return (140 million filers) will be forced to submit paperwork to the IRS showing they either had “qualifying” health insurance for every month of the tax year or they obtained an exemption to the mandate.
Americans liable for the surtax will pay according to the following schedule
1 Adult 2 Adults 3+ Adults
2014 1%AGI/$95 1%AGI/$190 1%AGI/$285
2015 2%AGI/$325 2%AGI/$650 2%AGI/$975
2016 2.5%AGI/$695 2.5%AGI/$1390 2.5%AGI/$2085
(Bill: PPACA; Page: 317-337)
Obamacare Employer Mandate Tax: If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2,000 for all full-time employees. This provision applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3,000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer). (Bill: PPACA; Page: 345-346)
Obamacare Tax on Health Insurers: Annual tax on the industry imposed relative to health insurance premiums collected that year. The tax phases in gradually until 2018. Fully imposed on firms with $50 million in profits. (Bill: PPACA; Page: 1,986-1,993)
Starting in tax year 2018:
Obamacare Tax on Union Member and Early Retiree Health Insurance Plans: Obamacare imposes a new 40 percent excise tax on high cost or “Cadillac” health insurance plans, effective in 2018. This tax increase will most directly affect union families and early retirees, who are likely to be covered by such plans. This Obamacare tax will be levied on insurance policies whose premiums exceed $10,200 for an individual and $27,500 for a family. Middle class union members tend to be covered by such plans in states like Ohio, Pennsylvania, Wisconsin, and Michigan. Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. (Bill: PPACA; Page: 1,941-1,956)