ObamaCare

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ObamaCare, formally known as "The Patient Protection and Affordable Care Act," (ACA) will impose massive penalties on young workers, small businesses and others who choose not to buy expensive health insurance, beginning in 2014. ObamaCare is the biggest handout by liberals to a single interest group — the health insurance industry — in American history. Even Democratic Senator Jim Webb admitted in 2012: Obamacare "cost Obama a lot of credibility as a leader."[1] On June 28, 2012, the Supreme Court of the United States upheld the constitutionality of Obamacare — by only one vote, 5-4 — as being within the taxing power of the federal government. Since then, leading Democrats have described ObamaCare as a "train wreck," and unions increasingly agree with conservatives that Obamacare should be repealed.[2]

The Association of American Physicians and Surgeons (AAPS) pointed out that there are no redeeming provisions of Obama's health care plan.[3] AAPS observes that Obama's health care plan will significantly increase the overall cost of health care for a majority of United States citizens, plus reduce the quality of care that a free market system would otherwise provide.[4]

Obamacare will soon cause havoc and harm to tens of millions of Americans: 28 million Americans will be caught in a "massive game of health coverage pingpong" due to Obamacare.[5]

As of April 2014, the House of Representatives has voted 55 times to scale back or repeal the law, but none of those proposals has received consideration in the Senate.[6]

Contents

Dr. Jane Orient, Director of the Association of American Physicians and Surgeons (AAPS). The conservative doctors' association the AAPS has always been against Obamacare while the liberal American Medical Association endorsed it.[7][8]

Obamacare is opposed by many state governors, including Florida Governor Rick Scott. He declared after the Supreme Court ruling, "I will not implement this law. Florida will not implement Obamacare." Scott encouraged other states to reject Obamacare in three ways:

  • opt out of the expensive Medicaid provision in ObamaCare, which would incur massive costs in extending free care to those over the poverty line
  • refuse to set up a health-insurance exchange - "If there were any value added by these exchanges, the private sector would be doing it already," Governor Scott observed
  • repeal Obamacare in Congress, which requires electing a Republican majority in the U.S. Senate

Obamacare was passed by Congress on March 21, 2010, and signed into federal law by President Barack Obama on March 23. This law furthers the process of socializing the United States health care system begun with Medicare.[9][10] The centerpiece of Obamacare is the individual mandate, a provision that makes it mandatory for every citizen to purchase private health insurance, which is unprecedented in American history. Through legislative mandates, Obamacare requires private citizens to purchase health insurance, involuntarily fund abortions, and pay for sex offenders to use Viagra under the threat of legal sanctions if they do not. The new law imposes penalties that will increase to 2.5% of one's income if he fails to purchase government-approved health insurance.

On June 28, 2012, the Supreme Court voted 5–4 that, while ObamaCare exceeded Congress’s authority under the commerce clause, the law was a permissible tax under the Constitution. [11]. The constitutionality of Obamacare was originally challenged under the theory that it exceeded the limitations of the commerce clause; more than 20 federal lawsuits have been filed against Obamacare since President Barack Obama signed it into law.[12][13] In total, 27 states have started or joined in a lawsuit against Obamacare.[14] A federal judge ruled on 13 December 2010 that a central component of ObamaCare, the requirement that most Americans carry insurance or pay a penalty, violates the Constitution. U.S. District Judge Henry E. Hudson is quoted as saying the law "exceeds the constitutional boundaries of congressional power."[15] Then on 31 January 2011 federal judge Roger Vinson ruled that as a result of the unconstitutionality of the "individual mandate" that requires people to buy insurance, the entire law must be declared void.[16][17] The U.S. district judge declared Obamacare unconstitutional because it violates the Commerce Clause. In a footnote attached to the ruling, federal judge Roger Vinson cited Barack Obama's position in 2008 from an interview with CNN, when Obama stated that, "If a mandate was the solution, we can try that to solve homelessness by mandating everybody to buy a house."[18]

The Congressional Budget Office (CBO) estimates the invasive revenue generating device could produce as much as $36 billion over ten years.[19] The fines are euphemistically dubbed "shared responsibility payments."[20] Employers would be required to deduct the penalties from employees' paychecks.[21] The State of Massachusetts has had a similar program in place for several years, and many have elected to pay the penalties rather than purchase insurance, and many remain uninsured.[22]

ObamaCare will do more than detrimentally impact healthcare accessibility. According to the Heritage Foundation, Obama is intentionally sacrificing millions of jobs, at a time when unemployment is around 10%, with the Medicare surtax without any objective exception of increases in revenues.[23] ObamaCare will cost 650,000 U.S. jobs if it is not repealed. The Congressional Budget Office says the figure would be more than 800,000 people would lose their jobs. [24]


Bill History

Background

In the 1940's in the wake of World War II, European countries and Canada rebuilt their health care systems on a single-payer model. However, the United States continued its system of private health care insurance, which was largely paid by employers to cover the health care of employees. Rep. John Dingell, Sr. introduced a bill to establish a national system of health care. When Dingell died in 1955, his son was elected to represent the same Michigan district in Congress. John Dingell, Jr. introduced the National Health Insurance Act, to provide universal health care in each session of congress.[25] In the Senate, Edward M. Kennedy advocated universal health care.

In 1965, Congress passed the law establishing Medicare - a single-payer insurance program for citizens over 65, which was funded through a federal payroll tax.

The United States Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986. EMTALA requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. EMTALA applies to virtually all U.S. hospitals. As a result, many people who could not afford to see a doctor came to hospital emergency rooms for non-emergency care. Because EMTALA does not have a way of paying for this care, hospitals raised the rates charged to other patients to cover these costs.

On April 12, 2006, Massachusetts Governor Mitt Romney signed state health legislation which provided for universal health coverage in that state.[26]

Obama during the 2008 elections had campaigned on healthcare reform, promising that the negotiations would not be behind closed doors, but televised publicly on C-Span.[27] He had also promised Planned Parenthood on July 17, 2007, that "reproductive care" would be central to the coming healthcare bill, and that he believed it important for Planned Parenthood to be part of the system[28]:

"Well, look, in my mind, reproductive care is essential care. It is basic care. So it is at the center and at the heart of the plan that I propose... Essentially what we are doing is to say that we're going to set up a public plan that all persons, and all women, can access if they don't have health insurance. It'll be a plan that will provide all essential services, including reproductive services, as well as mental health services, and disease-management services, because part of our interest is to make sure that we're putting more money into preventive care. And so many of women's diseases are preventable if they're getting access to regular care. So we subsidize women who don't have health insurance, or can't afford low group rates. We also will subsidize those who prefer to stay in the private insurance market, except the insurers are going to have to abide by the same rules in terms of providing comprehensive care, including reproductive care, and mental care services, and they won't be able to keep people out as a consequence of pre-existing conditions. So, that's going to be absolutely vital... I still believe that it is important for organizations like Planned Parenthood to be part of that system, because many young women for example may be much more comfortable when they're in college, or universities, or in other places, going to Planned Parenthood clinics and services, to get contraception, for example."

-Barack Obama before Planned Parenthood, July 17, 2007[29]

Democratic Supermajority

On April 28, 2009, the 2008 Wall Street Journal's prediction of a 'Liberal Supermajority'[30] proved correct; as the defection of Senator Arlen Specter from the Republican Party to the Democratic Party put the Democrats on the verge of one of the rarest blessings in politics, a Supermajority - complete control of the House, two-thirds of the Senate, and Presidency so that they wouldn't need a single Republican vote to pass bills.[31] Senator Bernie Sanders then urged the Democratic party to pursue single-payer healthcare reform.[32] On May 16, 2009, Barack Obama urged Congress to pass health care reform within the year, stating, "Our businesses will not be able to compete; our families will not be able to save or spend; our budgets will remain unsustainable unless we get health care costs under control".[33] On July 1, 2009, Al Franken was finally declared the winner of his election (narrowly winning by 312 votes[34]), giving the Democrats their desired Supermajority, and a clear path towards healthcare reform which Republicans would be powerless to stop.[35] Nevertheless, sickness of Ted Kennedy and Robert Byrd along with several other factors led to question marks about the supermajority's strength.[36] Democrats maintained this Supermajority until February 5, 2010, when Republican Scott Brown was sworn in to replace deceased Senator Edward Kennedy.[37]

Locking Out Republicans, Literally

Democrats were so confident that the 2008 elections displayed American backing for the Democratic Party that in October 2009 they even changed the door locks for the House Oversight and Government Reform Committee to keep Republicans from meeting when Democrats weren't present.[38] The debacle occurred because Republicans were trying to launch an investigation into corruption by Democrat Senators Kent Conrad and Chris Dodd for receiving special VIP loans from Countrywide Financial.[39] Democrats canceled the meeting by secretly leaving before the meeting was to begin, and a GOP staffer caught this on videotape, set it to the tune of "Hit the Road, Jack", and posted it on the Oversight and Government Reform Committee’s minority webpage for the press. Committee Chairman Sen. Edolphus Towns and the Democrats then had the locks changed in retaliation.[40]

Public Option Removed

On July 8, 2009, Barack Obama met with hospital lobbyists and struck a deal with the hospital industry to remove the public option in exchange for the industry's support of the bill, while also reducing costs for hospitals under the plan.[41]

"Not to worry, Jim Messina, the deputy White House chief of staff, told the hospital lobbyists, according to White House officials and lobbyists briefed on the call. The White House was standing behind the deal, Mr. Messina told them, capping the industry’s costs at a maximum of $155 billion over 10 years in exchange for its political support... Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying Medicare rates — generally 80 percent of private sector rates — or controlled by the secretary of health and human services. 'We have an agreement with the White House that I’m very confident will be seen all the way through conference,' one of the industry lobbyists, Chip Kahn, director of the Federation of American Hospitals, told a Capitol Hill newsletter."

-David Kirkpatrick, New York Times, Obama is Taking an Active Role in Talks on Health Care Plan[42]

In November 2009, an amendment proposed by Dennis Kucinich to let states have single-payer healthcare systems without insurance industry lawsuits was stripped from the healthcare bill because Nancy Pelosi said it would break Obama's promise to let people keep their current insurance plans if they liked them.[43] Kucinich expressed frustration with the move, stating, "They took single-payer off the table right at the beginning, because the table was set by insurance companies."[44] On March 25, 2010, Obama claimed the public option wasn't included "Because we couldn"t get it through Congress, that's why." He also on December 22, 2009 erroneously[45] claimed that he hadn't campaigned on a public option.[46] Following Obama's claim, a liberal group, The Progressive Change Campaign Committee, began airing television ads accusing Obama of breaking his promise of a single-payer healthcare plan.[47]

Tax on Medical Device Makers

The only healthcare industry to not readily acquiesce to the administration's demands for cooperation, medical device manufacturers, were hit with a 2.3% excise tax.[48] The Wall Street Journal suggested this was due to retaliation since the tax would add just $40 billion in funds for a bill costing $900 billion.[49] Medical device makers continue to accuse the tax of costing jobs in 2012.[50]

Role of Pro-Life Democrats

House Bill: H.R. 3962

Stupak's Resistance

In June and July 2009 some 200 Planned Parenthood activists arrived in Washington D.C.[51] and a number of Pro-Choice bills began receiving support, as the Pro-Choice movement sought to ensure abortion would be mandated in health care reform.[52] The Republicans would find an unlikely ally in the Pro-Life Democrats (Democrats for Life of America). On June 25, 2009, 19 of them, led by Congressman Bart Stupak, sent a letter to House leader Nancy Pelosi expressing refusal to support any healthcare bill with an abortion agenda[53], which firmly stated, "Therefore, we cannot support any health care reform proposal unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan... By ensuring that abortions are not funded through any health care reform package, we will take this controversial issue off the table so that Congress can focus on crafting a broadly-supported health care reform bill."[54]

In July, Stupak introduced the Stupak-Pitts amendment to ensure abortions would not be subsidized in the healthcare bill[55], but it was defeated 30-29 in the Energy and House Committee, the committee responsible for drafting it for proposal to the entire House of Representatives, when Bart Gordon sneakily switched his vote from Yes to No last minute.[56] Chairman Henry Waxman replaced it with the Capps amendment, which mandated one healthcare plan in each state must cover abortions.[57] On July 17, 2009, Obama once more urged rapid passage of the healthcare bill.[58] Pro-Life Democrats then, in mid-July, nearly stopped the healthcare process in its tracks by initially defeating a rule required to start healthcare reform legislation, 215-214, but Democrats managed to persuade a few members to change their votes, barely passing it.[59]

Obama on July 16 pressured Republicans to support the healthcare bill, even as the Congressional Budget Office criticized the proposed healthcare reform for not paying for itself.[60] Republicans criticized the lack of tort reform and insistence on covering 5.6 million illegal immigrants.[61] Obama predicted he would be held responsible if the bill failed, stating:

"You know, I intend to be president for a while and once the bill passes, I own it. And if people look and say, 'You know what? This hasn't reduced my costs. My premiums are still going up 25 percent, insurance companies are still jerking me around,' I'm the one who's going to be held responsible."[62]
Obama initially claimed that allegations of abortion in the healthcare bill were "fabrications" by "people who are bearing false witness."[63] On August 21, he said, in a radio talk show, that claims of abortion in the bill were "not true".[57] However, a detailed FactCheck.org analysis concluded Obama went too far in decrying claims of abortion in healthcare as fabrications, since his own previous promise of "reproductive services" in the bill coupled with the bill's wording showed that abortion likely would be subsidized by government under the bill.[64] On September 9, Obama continued to assert the bill would not fund abortions, promising immediately after Joe Wilson famously stood up and yelled "You lie!", that "Under our plan, no federal dollars will be used to fund abortions."[57]

In late September after 31 different Pro-Life Democrats had signed various letters opposing abortion in the healthcare bill, Nancy Pelosi and Obama began meeting with their leader, Bart Stupak, for the first time.[65] Stupak denied claims that he was trying to "kill" healthcare reform, stating publicly at the time, "I believe we need comprehensive healthcare reform and I am excited that we are closer than we have ever been to passing a healthcare reform bill in Congress. But any reform must address legitimate concerns, including using public funding for abortions, even if party leaders disagree."[66] On October 21, a coalition of Pro-Life groups led by key Republicans, including Mike Pence, delivered a petition signed by 137,000 Americans to Congress expressing disapproval with the healthcare reform legislation.[67]

Bill Introduced

On October 26, the House healthcare bill was unveiled, a 1,930 page piece of legislation, the Affordable Healthcare for America Act (H.R. 3962).[68] Representative Mike Pence (R-IN) accused the bill of being a "government takeover of health care in America".[69] By early November, the House was trying to pass the healthcare bill[70] but Bart Stupak claimed 40 Pro-Life Democrats could vote with him if his Stupak-Pitts Amendment was not voted on to prevent abortion funding in the bill.[71] With 218 votes required for passage, this would derail the historic vote set to occur on November 7.[72] While Senate Leader Harry Reid (D-UT) sought to create a separate bill in the Senate, he continued to lack the 60 votes needed for a public option, i.e. a government insurance program.[73]

Passage

Bart Stupak and his 40 Pro-Life Democrats refused to budge,[74] and Pelosi until the last day tried to play 'chicken', denying the Stupak Amendment its vote.[75] On November 7 Obama made personal last-minute contact with moderate Democrats in an attempt to persuade them to vote for the healthcare bill without Stupak's amendment.[76] A desperate Nancy Pelosi met with Bart Stupak last-minute and at his request, the Conference of Catholic Bishops[77], ultimately allowing the Stupak-Pitts amendment its vote, which passed by a vote of 240-194.[78] While some Republicans had considered voting 'Present' on the Stupak amendment to defeat it and thus perhaps healthcare reform, Pro-Life groups opposed the strategy and were scoring the vote so less than a 'Yes' would change a member's perfect Pro-Life rating.[79] Republican House leader John Boehner confronted Democrat Charles Rangel on the House floor, asking whether the Stupak language would be preserved in the final bill or removed in the end, stating, "I have my doubts this language if it passes has any chance of being in the final version of this bill".[80] Boehner refused to vote for the bill without a guarantee the language would be kept.[81]

"Republican congressional leaders have to be chuckling right now. In the end, all the tea-party town halls, Glenn Beck rallies and 'death panel' rumors may have less of a hand in bringing down health care reform than an intraparty Democratic culture war. Congressman Bart Stupak of Michigan, whose amendment restricting abortion coverage on all policies sold through the new insurance exchange paved the way for passage of health reform in the House of Representatives, vows that 'there will be hell to pay' if his language gets stripped out of, or weakened in, the final legislation."

-Amy Sullivan, Time Magazine, Can Dems Resolve Their Abortion Split?[82]

On November 8, 2009, the House healthcare bill, newly amended with the Pro-Life Stupak-Pitts amendment, narrowly passed the House by a vote of 220-215.[83] Joseph Cao was the only Republican to vote in favor of the bill.[84] 39 Democrats still voted against the bill, including many fiscally conservative Blue Dog Democrats and socially conservative Pro-Life Democrats affiliated with DFLA.[85]
Reaction

Afterwards, Obama stressed that it was time for the Senate to "take the baton."[86] Several Democrats including Debbie Wasserman Schultz (D-FL) revealed they voted for the bill only with the understanding that it would be removed from the final bill version.[87] The passage of Stupak's Pro-Life amendment in the House healthcare bill led to a letter signed by 40 Pro-Choice Senate Democrats, led by Dianna DeGette[88], saying that they would not pass healthcare reform unless Stupak's amendment was removed,[89] even as Senate Pro-Life Democrats vowed to reject any bills with abortion agendas. Senator Ben Nelson (D-NE) promised, "If it isn’t clear that government money is not to be used to fund abortions, I won’t vote for it," and Obama assured that "This is a health-care bill, not an abortion bill."[90]

On the Pro-Life side, a website, StopTheAbortionMandate.com, was created, and Susan's B. Anthony's List, an anti-abortion group, fund-raised in attacks on the bill, receiving contributions over 50% above the previous year's levels, which it used in advertising attacks on Sen. Harry Reid. On the Pro-Choice side, Stupak's stand drew the anger of liberal groups.[91] The Progressive Change Campaign Committee performed three "Stop Stupak" fundraisers and began issuing attack ads against him in his home state of Michigan.[92] CNN's Rachel Maddow predicted a revolt among women.[93]

Democratic Senator Barbara Boxer vowed to keep the Stupak-Pitts amendment from passing in the Senate.[88] White House Senior Advisor David Axelrod claimed Obama would intervene to change the Stupak language, and Stupak responded with "They're not going to take it out. If they do, health care will not move forward,. We won fair and square. ... That's why Mr. Axelrod's not a legislator. He doesn't really know what he's talking about."[94] Polls taken in mid-November showed public support for the Pro-Life Democrat position. 61% of Americans, according to a CNN/Opinion Research Corp. survey, oppose using federal money for abortions, while a CBS News poll found 56% oppose federal subsidies for abortions.[95]

Senate Bill: H.R. 3962

On November 18 the U.S. Senate under Senate Leader Harry Reid introduced its own health care bill (H.R. 3962 The Affordable Health Care for America Act), separate from the House bill. Obama called this bill a 'milestone' and urged Congress to pass it quickly.[96]

Senator Ben Nelson of Nebraska attempted to introduce the Nelson Amendment, a Pro-Life amendment identical to the Stupak-Pitts amendment, but it was defeated 54-45 on December 8.[97] Four Senators stood in the way of the bill's passage, Ben Nelson, Mary Landrieu, Blanche Lincoln, and Joe Lieberman.[98] By December 16th, both Landrieu and Lieberman had agreed to support the bill since its public option and Medicare expansions were removed.[99] Lieberman agreed only on condition that Medicare not be expanded to include Seniors as young as 55.[100] Landrieu in the process agreed to take $100 million in Medicaid money for her state, and was accused by Republican John Cornyn as having been "bribed".[101]

"We are approaching the eve of Christmas and maybe in that spirit, Senate Majority Leader Harry Reid morphed into Santa Claus, giving out presents to the little boys and girls who were naughty and (not so) nice this year. Of course, he was not using his own money. America's overused credit card, issued by the Bank of China, may have to be used one more time to pay for Reid's deals. The majority leader traded to help ensure the votes of Sens. Ben Nelson, Mary Landrieu, Chris Dodd, Bernie Sanders and others representing 11 states by giving them special perks for staying on the health care bus that's about to drive us all over the financial cliff."

-Ed Rollins, Harry Reid Playing Santa With Your Money, CNN.[102]

On December 19 following 13 hours of negotiations, Senator Nelson finally agree to back the Senate bill in exchange for tighter restrictions on abortion and increased Medicaid funding for his state.[103] The National Right to Life Committee opposed Nelson's compromise and said it was "light years removed" from the House bill's language per the Stupak Amendment.[104] A day later, both the RNC and Rick Santorum then initiated a robocall to 100,000 Nebraskans asking them to call Ben Nelson and ask him to reconsider.[105] On December 22nd, the GOP led by John McCain began accusing Nelson of a "Cornhusker Kickback" because his state had received $45 million of Medicare funding in the deal. Nelson denied this, claiming "I didn't ask for a special favor here".[106] Landrieu's deal was likewise criticized as the "Louisiana Purchase".[107]

Both the AARP and American Medical Association ran ads urging Senators to vote for the bill. On December 24, 2009, the Senate passed its bill on a party-line vote, 60-39, without a single Republican vote.[108]

Reconciliation

The possibility of splitting healthcare into two bills and reconciling them was rumored as early as August 20, 2009.[109]

[110]

Effort to Repeal

On January 19, 2011, the U.S. House of Representatives voted 245-189 to repeal Obamacare (56 percent to 44 percent). In an historic repudiation of an entitlement program that was only 10 months old, the House voted to overturn President Obama's health care takeover.[111][112] Repealing the bill would eliminate $770 billion in the newly mandated tax increases, according to the CBO.[113] The CBO released accounting data which shows that repealing the national health care law would reduce net government spending by $540 billion in the ten year period from 2012 through 2021; that number represents the cost of the new provisions, minus Medicare cuts. The Tea Party Movement firmly supports the proposed repeal of Obamacare.

On February 2, 2011, the U.S. Senate proceeded with a hearing to discuss the Patient Protection and Affordable Care Act and whether or not the individual mandate requiring Americans to purchase health insurance under penalty of a fine is constitutional.[114] The amendment to repeal Obamacare failed in the Senate by a 51-47 vote.[115]


The Individual Mandate requiring U.S. citizens to buy healthcare was upheld by the U.S. Supreme Court as constitutional in 2012. It is possible the entire bill could end up getting repealed.[116] A CBS News/New York Times poll taken March 21-25, 2012, found that just 26% of Americans want the Supreme Court to keep the entire healthcare law intact.[117]

Obama criticized the Supreme Court for considering the case, saying to overturn the bill would be "unprecedented" and was criticized by Senate Republican Leader Mitch McConnell, who said he should "back off. Let the Court do its work. Let our system work the way it was intended."[118] Following this, Obama conceded the Supreme Court does have the power to overturn the bill.[119]

The Congressional Budget Office in 2011 projected that repealing the bill would add $211 billion to the deficit, but this was contradicted in April 2012 by economist Charles Blahouse who said the bill adds $340 billion to the deficit.[120]

As of April 2014, the House of Representatives has voted 55 times to scale back or repeal the law, but none of those proposals has received consideration in the Senate.[6]

In October 2013, the Congress needed to adopt a continuing resolution to allow the federal government to remain open after the existing appropriation laws expired. The House adopted a series of continuing resolutions which were conditioned upon the repeal or modification of the ACA. However, the Senate adopted a series of continuing resolutions which did not contain such ACA conditions. As a result of the impasse, many federal programs were shut down, and remained shut until the House agreed to funding without ACA conditions.

Basic Requirements

Beginning in 2014, Americans are required to buy government-approved, private health insurance or else pay a penalty.

Health insurance companies will be required to spend on medical care at least 80% of the premium payments they receive from individual and small-group plans (and at least 85% from large group plans). The federal government will define what constitutes medical care.

Immediate Impact in 2010

Creating temporary high-risk pool with subsidized premiums for certain people with pre-existing conditions.

Imposing new taxes on some facilities, such as tanning parlors.

Health insurers raised premiums for Americans as a direct result of President Obama's health care overhaul.[121][122]

Requirements for Insurance Companies

Prohibit bans on pre-existing health conditions in children, lifetime and annual limits on expenses, and limits coverage exclusions of pre-existing health conditions in adults.

Requires family policies to include coverage of children up to age 26.

Allows states to form compacts in order to allow the interstate sale of insurance.

Requires direct access to obstetrical and gynecological care, which might include abortion.

Creates (starting in October 2013) health insurance exchanges or marketplaces that will be state-based and state-administered, but states can opt out of this if certain conditions are met; insurance can be sold within the exchange only if government-approved. If a state fails to set up its own exchange, residents of the state can purchase insurance on a federally-administered exchange. Insurance can be sold outside of the exchange, but only policies purchased on the exchange will be eligible for a premium tax credit.[123]

Prohibits health plans from discriminating against providers, but plans are not required to contract with any provider.

Requires health plans to develop politically correct language services, community outreach and cultural competency trainings.

Requires "silver" insurance plans sold on the exchange to implement a premium tax credit program for individuals making less than $45,960 ($94,200 for a family of four).[123] The insurance company receives the credit from the federal government and is responsible for billing the difference to each insured person.

Employer Requirements

Requires that employers with more than 50 full-time employees provide health insurance or pay a penalty.

Employers with 25 or fewer full-time employees, receiving average salaries of $50,000 or less, can apply for tax credits in order to provide their employees with health insurance.

Medicaid

Obamacare expands Medicaid (medical care for the poor) to everyone (under the Medicare age of 65) who has income less than 133% the federal poverty level. States must pay this enormous new burden, but federal government promises to reimburse costs of newly eligible patients under this program from 2014 to 2016. Although the law was drafted to make this a required part of the existing Medicare program, the Supreme Court considered an appeal from certain states and interpreted the law as giving each state the option to either retain the prior scope of Medicaid or expand Medicaid. If a state refuses to expand Medicaid, the taxes collected from that state will be redirected to states that have expanded Medicaid, and hospitals will still be required to provide medical care to the uncovered individuals without reimbursement.

On April 10, 2014, Secretary of Health and Human Services Sebelius acknowledged there are extensive backlogs of people in some states who have applied for Medicaid but remain unable to access care because of out-of-date state computer systems. In April 2014, the government said three million people had enrolled in Medicaid from October 1 through February 28.[124]

New Bureaucracy

Establishes a new Consumer Operated and Oriented Plan (CO-OP) program with the goal of creating non-profit, member-run health insurance companies in every state

Impact on the deficit and expanded welfare spending

The Congressional Budget Office (CBO) projects that Obamacare’s refundable health insurance tax credits (or tax expenditures[125] in D.C. parlance) will add to the national debt $1.36 trillion in the first seven years of implamentation. 85% of filers who claim the tax credit will end the year with zero or negative income tax liability. Since the tax credit is refundable, nearly all 11.3 million of these filers will have negative income tax liability and will no longer pay the cost of government by contributing federal income taxes. Tax credits, or tax expenditures, are a form of federal un-appropriated backdoor spending.

For example, a family of four at 200 percent of the Federal Poverty Level (about $48,677 in 2016) cannot pay more than 6.3% of their income for health insurance. The CBO estimates that the average cost of the reference insurance plan (the plan used to calculate the tax credit) will be $14,100 for family coverage in 2016. Therefore, a family of four that qualifies for a credit in 2016 and that makes $48,677 would be required to pay about $3,067 for health insurance (6.3% of household income). The difference, $11,033, is the value of this family’s refundable tax credit. According to the CBO, 20 million Americans will receive health insurance tax credits in 2020 at a cost of $130 billion.[126]

Basis for Legal Challenges

Commerce Clause

There have been several grounds for challenging the Cosntitutionality of the bill. Obamacare includes an "individual responsibility requirement" compelling persons to buy health insurance or pay a penalty. The one legal justification for this requirement by Congress is the Commerce Clause:

The individual responsibility requirement provided for in this section ... is commercial and economic in nature, and substantially affects interstate commerce, as a result of the effects described in paragraph (2). ... [Paragraph (2) states,] The requirement regulates activity that is commercial and economic in nature: economic and financial decisions about how and when health care is paid for, and when health insurance is purchased.

Apparently uncertain that this would withstand legal scrutiny as a valid exercise of Commerce Clause authority, on March 21 (the same day as passage) the Joint Committee on Taxation released a 157-page "technical explanation" of the bill. This "explanation" grounded the justification for the bill in the tax authority of Congress, and nowhere mentioned commerce. As Professor Randy Barnett explained in an article on April 29, 2010 in the Wall Street Journal:

The word "commerce" appeared nowhere. Instead, the personal mandate is dubbed an "Excise Tax on Individuals Without Essential Health Benefits Coverage." But while the enacted bill does impose excise taxes on "high cost," employer-sponsored insurance plans and "indoor tanning services," the statute never describes the regulatory "penalty" it imposes for violating the mandate as an "excise tax." It is expressly called a "penalty."

Professor Barnett then explained that in Bailey v. Drexel Furniture (1922), "the Supreme Court struck down such a penalty saying, 'there comes a time in the extension of the penalizing features of the so-called tax when it loses its character as such and becomes a mere penalty with the characteristics of regulation and punishment.'" A subsequent Supreme Court decision, U.S. v. Kahriger (1953), upheld a punitive tax on gambling based on an express statement in the law that Congress was exercising its power to tax. No such statement exists in Obamacare. See also Sonzinsky v. U.S. (1937) ("Inquiry into the hidden motives which may move Congress to exercise a power constitutionally conferred upon it is beyond the competency of courts."). Professor Barnett noted that the penalty is not enforced as a tax in a customary manner, providing further evidence that Obamacare is based on the Commerce Clause and not on any taxing authority.

Requiring Americans to buy insurance "would invite unbridled exercise of federal police powers," wrote Judge Hudson, a George W. Bush appointee in the Eastern District of Virginia. The federal judge also wrote:

At its core, this dispute is not simply about regulating the business of insurance—or crafting a scheme of universal health insurance coverage—it's about an individual's right to choose to participate.[15]

It has also been pointed out that because the penalty applies to inactivity, it is beyond the powers authorized by the Sixteenth Amendment.

Since the federal judge decided the entire healthcare reform bill law was unconstitutional, states such as Alaska have decided not to implement the mandated reforms. [127] This prompted Obama's Justice Department to appeal to Judge Vinson by claiming that states cannot ignore the new health care law while his ruling is being appealed.

Origination Clause

On September 12, 2012, the Pacific Legal Foundation filed suit in a Washington, D.C., federal court, arguing that the mandate is unconstitutional under the Origination clause.[128] The Origination Clause (Article I, Section 7, clause 1 of the Constitution) provides that "All Bills for raising Revenue shall originate in the House of Representatives; but the Senate may propose or concur with Amendments as on other Bills."

On September 17, 2009, Congressman Charlie Rangel introduced a bill in the House, H.R. 3590, the "Service Members Home Ownership Tax Act of 2009," whose purpose was "to amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees." The bill passed the House on October 8 by a 416-0 vote.

On November 19, Harry Reid introduced his own version of H.R. 3590 in the Senate. He took the bill that had been unanimously passed by the House, renamed it the "Patient Protection and Affordable Care Act," deleted all its contents after the first sentence, and replaced it with totally different content. What followed was the first pass of the Senate version of Obamacare.[129]

Thus, the only portion of Obamacare to originate in the House was its number. Congress frequently uses this same practice for many years, and if the Supreme Court were to overturn the law based on the Origination Clause, a large number of other laws would be open to court challenge as well.

History of Mandatory Coverage

One of the early proposals (a predecessor to the one enacted) would create a system to require adults (over age 19, U.S. citizens, not incarcerated) to enroll themselves and dependent children in a plan through the state-wide Health Help Agency (HHA) unless they provide evidence of enrollment or coverage through Medicare, a health insurance plan offered by the Department of Defense, an employee benefit plan through a former employer (i.e. retiree health plans), a qualified collective bargaining agreement, the Department of Veterans Affairs, or the Indian Health Service. The law contains a religious exemption for people, such as Christian Scientists who do not receive health care. 26 U.S.C. § 5000A(d)(2). Each adult would have the responsibility to enroll each child in a plan. Dependent children include individuals up to age 24 claimed by their parents for deductions in the tax code.

If an individual fails to purchase coverage and does not meet the exceptions or the religious exemption, then under Obamacare a financial penalty may be assessed for non-indigent individuals. (Image courtesy See-Ming Lee)

History of Penalty for Failure to Purchase Coverage

Monthly payments for Obamacare are massive, roughly 12-15% of an individual's annual salary. If an individual fails to purchase coverage and does not meet the exceptions or the religious exemption, then a financial penalty will be assessed for non-indigent individuals. An exemption is available if more than 8% of the individual's household income would be required to pay for the cheapest available coverage.[130]

Fines were to be paid to the HHA of the State in which the person resides. That agency also may establish a procedure to waive the penalty if the penalty poses a hardship. Each State would determine appropriate mechanisms to enforce the requirement that individuals be enrolled.[131]

The law that was enacted replaced the state-based approach with a direct penalty to be paid to the United States.

Privacy Rights

Section 163 of the America’s Affordable Health Choices Act of 2009 would have "require[d] the Secretary of HHS to adopt standards for typical transactions between insurers and providers such as claims, eligibility, enrollment, and prior authorization building on the standards in the Health Insurance Portability and Accountability Act of 1996".[132]

Rationed Care

Doctors have said they anticipate more people waiting in the waiting-rooms, more phone calls, people upset because they want to be seen now. Doctors will be overbooked. As the health care system brings in more and more patients, the system will be overwhelmed. Obamacare will be a tremendous burden for doctors in the United States.

Obamacare will shorten the amount of time Doctors have with each patient, and lengthen the amount of time patients will have to wait. Dr. Sreedhar Potarazu said that the current bill passed into law will create a scenario where the supply cannot meet the demand. Because the necessary health care reform needs are not included in Obamacare, there are still no protections for physicians in the medical industry, and doctors are going into the profession to work harder to earn less.

There will be an oversight board where the government looks at what should and shouldn't be given to patients, regardless of medical need. There is going to be rationing of care, according to Dr. Sreedhar Potarazu. Doctors have agreed there will be "rationed care" under Obamacare.[133]

Disinformation

If private citizens have disagreements, discussions, and dissections of Obamacare, the proposed expansion of federal debt and deficits through its planned regulation of the healthcare industry, whether its communicated through e-mail, websites, blogs, or even casual conversation the Obama administration has asked that these people be reported to the executive branch of the federal government.[134] To counter any discussions related to the repeal of Obamacare, or that are against the implementation of Obamacare which will in turn destroy jobs and create more taxpayer debt, a Web page at whitehouse.gov entitled "Reality Check" has claimed that the president's program "would be fully paid for over 10 years, and it would not add one penny to the deficit."[135]

The CBO is mandated to prepare cost estimates and to show how individual legislative proposals would change spending or revenue levels under current law.[136] A July 15 2009 letter from the CBO made this assessment,

Enacting the proposal would result in a net increase in the federal budget deficits of about $1.0 trillion over the 2010-2019 period."[137]
However, deceptively, CBO analysis of the House and Senate versions of the health care reform bills show that they would reduce the federal budget deficit by $109 billion [138] and $81 billion [139] respectively.

In a 2010 report, HHS claimed a provision in the health-care law would extend the Medicare trust fund by 12 years. The Congressional Budget Office released a memo that said HHS’s math was more than a little off.

Health and Human Services Secretary Kathleen Sebelius appearing on Capitol Hill for questioning admitted to double-counting in the Obamacare budget. Rep. Joe Pitts of Pennsylvania said “The same dollar can’t be used twice. This is the largest of the many budget gimmicks Democrats used to claim Obamacare would reduce the deficit.” [140]


Implementation

States implementing Medicare Expansion[141]
StateStatus as of April 2014
AlabamaNot Moving Forward at this Time
AlaskaNot Moving Forward at this Time
ArizonaImplementing Expansion in 2014
ArkansasImplementing Expansion in 2014[note 1]
CaliforniaImplementing Expansion in 2014
ColoradoImplementing Expansion in 2014
ConnecticutImplementing Expansion in 2014
DelawareImplementing Expansion in 2014
District of ColumbiaImplementing Expansion in 2014
FloridaNot Moving Forward at this Time
GeorgiaNot Moving Forward at this Time
HawaiiImplementing Expansion in 2014
IdahoNot Moving Forward at this Time
IllinoisImplementing Expansion in 2014
IndianaOpen Debate[note 2]
IowaImplementing Expansion in 2014[note 1]
KansasNot Moving Forward at this Time
KentuckyImplementing Expansion in 2014
LouisianaNot Moving Forward at this Time
MaineNot Moving Forward at this Time
MarylandImplementing Expansion in 2014
MassachusettsImplementing Expansion in 2014
MichiganImplementing Expansion in 2014[note 3]
MinnesotaImplementing Expansion in 2014
MississippiNot Moving Forward at this Time
MissouriOpen Debate
MontanaNot Moving Forward at this Time
NebraskaNot Moving Forward at this Time
NevadaImplementing Expansion in 2014
New HampshireImplementing Expansion in 2014[note 4]
New JerseyImplementing Expansion in 2014
New MexicoImplementing Expansion in 2014
New YorkImplementing Expansion in 2014
North CarolinaNot Moving Forward at this Time
North DakotaImplementing Expansion in 2014
OhioImplementing Expansion in 2014
OklahomaNot Moving Forward at this Time
OregonImplementing Expansion in 2014
PennsylvaniaOpen Debate[note 2]
Rhode IslandImplementing Expansion in 2014
South CarolinaNot Moving Forward at this Time
South DakotaNot Moving Forward at this Time
TennesseeNot Moving Forward at this Time
TexasNot Moving Forward at this Time
UtahOpen Debate
VermontImplementing Expansion in 2014
VirginiaOpen Debate
WashingtonImplementing Expansion in 2014
West VirginiaImplementing Expansion in 2014
WisconsinNot Moving Forward at this Time[note 5]
WyomingNot Moving Forward at this Time

The ACA as passed assumed that the eligibility for Medicaid would be automatically expanded in all 50 states. However, some states appealed this provision, and the US Supreme Court ruled that each state would have the right to decide whether to continue Medicaid on its present terms or to expand Medicaid to cover more low-income individuals. Although the ACA provided for the federal government to pay for all costs of medicaid expansion during the first four years, there was no statutory guarantee for full federal funding after that time. So, some states, particularly those with Republican Governors or Republican-controlled legislatures, refused to expand the eligibility requirements for the Medicaid program in their states. However, hospitals faced financial pressures to limit or end free charity care for indigent patients under the new structure, leaving low-income people in a difficult, un-insured dilemma.

Individuals and families who earned enough money to not qualify for Medicaid, and were not covered by employer-provided insurance, were then required to purchase insurance through health care exchanges in order to receive federal subsidies of insurance premiums and deductibles. However, there were massive problems with the online health care exchanges operated by the federal government for states that did not set up their own exchanges. This was true at the start of the open season in October 2013 as well as toward the end of the open season in March 2014. Despite these problems, 7.5 million people signed up for insurance on the exchanges.[124][142] This number does not indicate a growth in the number of people covered by private health insurance. First, the 7.5 million includes people who became covered by Medicaid expansion. Second, some of the people were already covered by a grandfathered health plan, but were forced to purchase on the exchange so as to receive premium and deductible subsidies. Third, some states, like California, required insurance companies to cancel their existing insurance plans as a precondition of offering plans on the health care exchanges. Fourth, purchasing a plan and signing-up are two very different criteria in determining the viability of government healthcare. The Obama administration has declined to provide "paid for" statistics.

Some people thought that they had purchased insurance through the exchange, but because of malfunctions in the back office of the exchange, the insurance providers did not receive any record of the insurance purchase. The Obama Administration launched a crash program to fix the federal exchange software and in January 2014 replaced the contractor responsible for building and operating the healthcare.gov website.[143]

Although a number of Americans gave up their grandfathered health care plans for new policies. If the number of people purchasing policies under the ACA is not sufficient, insurance companies will raise their rates in future years, perhaps trapping these Americans who gave up their rights to switch back to the grandfathered plans.

The ACA imposed a mandate for employers who hire more than 50 full time employees. A full time employee is defined as someone who works 30 or more hours per week. In response, some employers have cutback the number of full time employees to avoid the duty to comply with the ACA's insurance requirements. The Obama Administration has postponed the implementation of the employer mandate until 2015. Some employers have cut the hours that their staff could work to under 30 hours per week. For example, adjunct faculty members have found that the number of classes per semester have been reduced so that they will not be covered by employer insurance. House Republicans have passed legislation through the House to increase the definition of full time worker to 40 hours per week.[6]

The ACA requires health plans to offer women family planning and contraceptive services. Some employers object that such coverage violates religious principles. This issue has been taken to the United States Supreme Court with a decision expected by the summer of 2014.

Following the troubled roll-out of the ACA, on April 11, 2014, U.S. Health and Human Services Secretary Kathleen Sebelius announced her resignation.[144]

Obama Administration health care plan and liberal elitism

See also: Barack Obama and liberal elitism and Barack Obama and uncharitableness

In 2007, when Obama was running for the office of President of the United States, he promised Americans "health care that is as good as the health care that I have as a member of Congress."[145] The ACA has a provision which requires members of Congress and their staff to purchase insurance on a health care exchange instead of from the health care plans offered through the federal Office of Personnel Management (OPM). The Obama Administration wrote implementing regulations which would have Congress and their staff receive a subsidy on the exchange-purchased insurance equal to the amount that OPM subsidizes the insurance of all other federal employees. However, during the October 2013 government shutdown crisis, one of the provisions the House added to one of the continuing resolution to fund the federal government was a prohibition of such a subsidy. The Senate rejected it.[146]

The Obama administration's liberal elitism is not unusual when it comes to health care. For example, Belinda Stronach, a former Member of the Canadian Parliament, chose to have a surgical treatment in the United States rather than be treated in Canada for her condition (Canada has a socialized medicine system of health care).[147]

MedSybolBlog.jpg

Congressman John Fleming has offered a legislative amendment that would require United States congressmen and senators to take the same health care plan they try to force on others (under proposed legislation they are curiously exempt). Congressman Fleming is encouraging people to go to his website and sign his petition.[148] Fleming and other Congressmen advocate ending the health care plans offered through OPM and placing all federal employees under the health care exchanges.[149]

Two-Tier Health Care System

Socialist regimes reveal their true nature by the special treatment they give to their permanent ruling class; they deny such treatment for ordinary citizens of their country. The worst corruption in socialist regimes flows from that simple two-caste system. Some critics claim there is a two-tier health care system under the ACA.[150]

The first example of Obamacare's creation of a two-tier health care system was seen as millions of hardworking Americans struggle to make ends meet and watch as their health care costs increase due to provisions in Obamacare. Senate staffers planned to participate in a two-day orgy of back massages, organic food tastings and milk mustache photos as part of a "health fair" for the staffers, who enjoy some of the best health care in the country.[151] The Senate staffers will be treated to seated massages, herbal teas, polarity therapy, low-fat cheese samples and organic foods. A pharmacist and health coach will be available to speak to fair-goers about their medications, nutrition and healthy lifestyle questions. All of which is at the American taxpayers expense. Of course, the ACA provisions regarding employee health care had not gone into effect at the time of that proposed health fair.

Less than one year after Obamacare was signed into law, 111 unions, companies, and organizations had received approval for Waiver of the Annual Limits Requirements of the PHS Act Section 2711.[152][153][154][155] By December 7, 2010, the list of unions, companies, and insurers who have used the HHS waiver as an escape to avoid the costly, destructive consequences of Obamacare for their members and employees grew from 111 to 222.[156][153] More than 50 unions have already received waivers.[157] Moreover, three Service Employees International Union (SEIU) local chapters, including the Chicago chapter, whose political action committee spent $27 million supporting Barack Obama in the 2008 presidential election, have received waivers from a provision in the Obamacare law.[158]

Treatment of older patients

Some critics, including 2008 Vice-Presidential candidate Sarah Palin, have accused Obama of planning on setting up "Death Panels" to judge the worthiness and "cost effectiveness" of keeping certain people alive, such as senior citizens. In spite of public outcry over death panels, the Obama administration is pressing forward to enact the same measures by bureaucratic regulations, called "end-of-life planning."[159] Quoting research from the British Medical Journal, the Obama administration insists death panels are humane: "Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives." Prior to ObamaCare, uninsured indigent patients would be subject to rationing of care dictated by the limited amount of charity funding available at local hospitals. Insurance companies also rationed care by declining to authorize and reimburse procedures and treatments that they considered wasteful or experimental.

This "end-of-life" care is apparently to be doled out like pork from a salt barrel from the 200 or so "Elderly Care Centers" nationwide that will distribute strictly rationed medication to those in need until such time as the "committee" considers the patient to be too old. 200 centers in the country amounts to about 4 per state on average, though California, Massachusetts and Iowa were able to grab more funding from the Obama administration through a combination of political dealings and judicial activism [160] The majority of Elderly Care Centers are located in urban areas of states; for example, the state of Kansas has only two Elderly Care Centers for their entire retired population and both are located in Topeka, far from the rural elderly who "need" government help the most. This may be a strategy to reduce the strain on the system by allowing a large portion of the elderly to die off "naturally," while still making a show of treating them in cities, where liberal voters tend to congregate.

There have already been deaths attributed to doctors exercising newly-granted authority from these extra-judicial decision making bodies. A young girl, in liberal California of all places, was told that her liver transplant was not "worth it," because she wouldn't live long enough to justify the value of the organ. Though public outcry forced the doctors to change their minds after ten days, but those ten days were enough to kill an innocent child. Another woman, a nurse in Texas, was denied treatment for her breast cancer, purportedly because she was in middle age and was not worth the "investment." [161]

Under Obamacare, in every state taxpayer dollars originally slated for caring for the elderly in our communities have been transferred to a "Community Health" slush fund run by federal government-appointed bureaucrats. The purpose of this fund is to allow unscrupulous doctors and insurance companies, who are the acknowledged source of our high health costs, to charge ridiculous amounts of money for basic services, without leaving a paper trail or even committing a (legal) crime.

Polls

Taken from an AP poll, on January 17, 2011, Kellyanne Conway, president of the polling company, inc./WomanTrend, pointed out that when asked if voters would favor a law "that would require every American to have health insurance, or pay money to the government as a penalty if they do not, unless the person is very poor," 59 percent are opposed.[162]

When they actually hear what the health care reform is, they’re opposed to it," Conway said.

One week after a federal district judge ruled in favor of 26 states and declared Obamacare to be unconstitutional, Rasmussen's poll of likely voters showed that Americans support its repeal by a margin of 21 percentage points (58 to 37 percent). Among independents, the margin in support of repeal was even higher: 27 points (63 to 36 percent).[163] The pollsters also point out that many voters don't just want Obamacare repealed — they also want it replaced with a better system.

  • On August 29, 2011, the Rasmussen Reports national telephone survey of Likely U.S. Voters showed that 57% at least somewhat favor repeal of the health care law, including 46% who Strongly Favor repeal. Thirty-seven percent (37%) at least somewhat oppose repeal, with 25% who are Strongly Opposed.[164]
  • According to the Kaiser Health Tracking poll, as reported on August 30, 2011, 44% of Americans have an unfavorable view of Obamacare. Only 39% of those surveyed have a favorable view of the law.[165]
  • According to a monthly poll from the Kaiser Family Foundation, as reported by The Hill on October 28, 2011, 51 percent of respondents had an unfavorable view while only 34 percent had a favorable impression of Obamacare.[166]

See also

Dr Obama.jpg

External links

Notes

  1. 1.0 1.1 AR and IA have approved Section 1115 waivers for Medicaid expansion.
  2. 2.0 2.1 IN and PA have pending waivers for alternative Medicaid expansion plans.
  3. MI has an approved waiver for expansion and plans to implement in April 2014.
  4. NH has passed legislation approving the Medicaid expansion that is expected to be signed by the Governor in March 2014. While the state plans to seek a waiver at a later date, the legislation calls for the expansion to begin July 1, 2014.
  5. WI amended its Medicaid state plan and existing Section 1115 waiver to cover adults up to 100% FPL in Medicaid, but did not adopt the expansion.

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