It shouldn’t be a surprise by now: under ObamaCare, health-insurance premiums will increase, companies will struggle to stay afloat and doctors will earn less money.
Washington is taking a step into ensuring that the rates physicians are collecting while working for hospital-owned clinics are lower than the rates they currently collect. According to Medicare Payment Advisory Commission, the current arrangement that ensures hospitals can bill Medicare at higher rates for services provided by their physicians should be invalidated, given that physicians can offer the same services in different settings. The system that served physicians looking for a way to make up for their declining incomes by establishing long-term contracts with hospitals or hospital-owned clinics could soon collapse. Physicians that once saw an advantage in seeing patients at hospitals in order to counterbalance the high cost of running their own medical practice will no longer see any convenience in maintaining the agreement with hospital-owned clinics.
To offset the expensive mandates, insurance providers must limit what healthcare providers are paid by also controlling what they can and cannot do. While the proposal introduced by the MedPAC is still being considered, it could serve as a strong indicator for future policy making.
While doctors might be losing incentives to work with hospitals when ObamaCare kicks in, employers are already losing incentives to keep employees under full-time contracts.
Over at R Street, Andrew Moylan makes a fascinating comment regarding President Obama’s recent speech on climate change and his plan to reduce carbon emissions. To wit: doesn’t matter much what your personal opinion is on carbon emissions and their relationship (or lack of relationship) to the already-defined-as-fact (accurately or not) science of climate change, the issue will be addressed by the federal government:
Moylan concluded by saying, “Regardless of one’s views on climate change, the simple reality is that federal policy is going to address the matter. That can happen through ill-advised regulations, like those proposed by the President today, or it can happen through a vibrant market with clear price signals attached to all fuels. Conservatives should seize the opportunity to once again emphasize the superiority of free markets over central planning.”
On climate change and the President’s plan specifically, it’s hard to accept something that will cost the country hundreds of thousands of lost jobs and $1.47 trillion of lost national income by 2030, according to a report by the Heritage Foundation. And, to Moylan’s point, it’s a situation conservatives, libertarians, and those who lean center-right on economic issues should begin to get in front of by doing the work of presenting their own plans to address something people are convinced needs addressing.
“[I]f people can’t trust not only the executive branch but also don’t trust Congress and don’t trust federal judges to make sure that we’re abiding by the Constitution, due process and Rule of Law, then we’re going to have some problems here.” — Barack Obama
Those words were uttered by Obama recently in response to the unfolding scandal surrounding the revelation that the NSA is collecting data on every American, and I have to agree with him. If we can’t trust our very own government, made up of elected officials who have taken an oath to protect and defend the Constitution from all enemies, foreign and domestic; and if we can’t trust the army of bureaucrats employed by government to execute these laws and policies, then we do indeed have a problem.
And for all of those Americans currently engaged in weeping and wailing and gnashing of teeth, who are acting as if this monitoring of the private thoughts of every American is somehow sinister and unconstitutional, who “…warn that tyranny [is] always lurking just around the corner”, as Obama said to the students at Ohio State University; well, as Obama also said “You should reject these voices. Because what they suggest is that our brave, and creative, and unique experiment in self-rule is somehow just a sham with which we can’t be trusted.”
And why shouldn’t we trust our government? It’s not like the NSA (National Security Agency) has been collecting data on virtually every phone call, text message, email, internet search, Facebook post, and pretty much all other forms of digital communication used by more than 300 million Americans.
Written by Michael F. Cannon, Director of Health Policy Studies at the Cato Institute. Posted with permission from Cato @ Liberty.
The latest Kaiser Family Foundation tracking poll provides a fascinating look into how factors other than the content of the Patient Protection and Affordable Care Act affect people’s views of that law.
Kaiser asked respondents their views of the PPACA, alternately describing it as “ObamaCare” and “the health reform law.” Here’s what happened:
- Among Republicans, calling it “ObamaCare” caused the share reporting an unfavorable view to rise from 76 percent to 86 percent (+10 percentage points), with no discernible change in the share reporting a favorable view.
- Among independents, calling it “ObamaCare” caused the share reporting an unfavorable view to rise from 43 percent to 52 percent (+9 percentage points), with no discernible change in the share reporting a favorable view.
- Among Democrats, calling it “ObamaCare” produced no discernible change in the share reporting an unfavorable view, but caused the share reporting a favorable view to rise from 58 percent to 73 percent (+15 percentage points).
A few conclusions can be drawn.
On Monday, Arizona Governor Jan Brewer signed into law the state’s budget opting in to the ObamaCare Medicaid expansion program. It was the capstone of a long, hard fought battle by Gov. Brewer to impose the expansion on the state of Arizona and its startled citizenry.
How did we come to the point where a Republican governor in a conservative state would stake her political career on choosing to implement ObamaCare’s massive expansion of the welfare state?
ObamaCare Medicaid Expansion is Optional
PPACA Section 2001 expanded Medicaid up to 133% of the federal poverty line. It also provided federal funding for the increase as follows:
(A) 100 percent for calendar quarters in 2014, 2015, and 2016;
(B) 95 percent for calendar quarters in 2017;
(C) 94 percent for calendar quarters in 2018;
(D) 93 percent for calendar quarters in 2019; and
(E) 90 percent for calendar quarters in 2020 and each year thereafter.
Then came the Supreme Court’s ruling on the individual mandate in NFIB v. Sebelius. Chief Justice Roberts inexplicably upheld the mandate as a tax, a holding that will forever define his legacy as having abandoned originalism. But there was one minor victory for the states:
If you can’t beat them, force them to join their own thing.
That may as well have been Senator Chuck Grassley’s (R-IA) motto in 2009 when he introduced an amendment to PPACA to force members of Congress and their staff onto the ObamaCare exchanges. In the private sector, this practice of dropping large employee groups or terminating employer-sponsored group health plans is referred to as “dumping” employees onto the ObamaCare exchange. Congress and its staff will certainly feel dumped on come January 1, 2014, when they’re left to fend for themselves in the world of government-driven healthcare.
What is the FEHBP?
The Federal Employees Health Benefits Program (FEHBP) is the group health plan for federal government employees. It’s the largest employer-sponsored plan in the country, covering 8 million enrollees. That’s roughly the size of the entire population of the entire Commonwealth of Virginia.
Why Members of Congress and Staff Lose FEHBP Coverage as of January 1, 2014
PPACA Section 1312 explicitly requires that they go to the ObamaCare exchange:
Former IRS Commissioner Douglas Shulman and current Acting IRS Commissioner Steven Miller have been the subjects of intense questioning from Congress over the past two weeks over their relation to the Tea Party targeting scandal. For Shulman, questions remain as to whether he may have lied in front of the House Ways and Means Committee in March 2012 when questioned about allegations of targeting that at the time were simmering without mainstream awareness. He appeared to be less than forthright in his responses when questioned by the House Oversight and Government Reform Committee on Wednesday. Miller has already tendered his resignation under pressure.
But there’s another IRS scandal waiting to gain widespread awareness, and this time it undeniably has Shumlan’s and MIller’s fingerprints all over it. The IRS is unconstitutionally implementing ObamaCare exchange subsidies in states that refuse to establish an exchange.
What PPACA Says
Former House Speaker Nancy Pelosi (D-CA) infamously stated in 2010 that “we have to pass the bill [ObamaCare] so that you can find out what is in it.” It was a curious comment, one that could have any number of meanings. Here’s what I understood it to mean: This bill is so damn big, has so many moving parts, and will radically remodel the relationship between the civil society and government to such a degree that there is no way for Americans to conceptualize what life will be like under the ObamaCare utopia until we implement it.
Well, the time is nigh. And for employers, guess what? You’re really about to find out what’s in it. The employer mandate and its associated excise tax penalties are a cornerstone of the fundamental transformation President Obama has so long desired. In the ObamaCare solar system, everything revolves around the exchanges. Employer mandate excise taxes, enforced by the same IRS that recently admitted to targeting Tea Party groups, will provide crucial funding for the massive exchange subsidies.
One of the ObamaCare requirements associated with the employer mandate that has been largely under the radar until this week is requirement to provide employees with a notice informing them about the ObamaCare exchanges. From Section 1512 of PPACA:
PART II—EMPLOYER RESPONSIBILITIES
SEC. 1512. EMPLOYER REQUIREMENT TO INFORM EMPLOYEES OF COVERAGE OPTIONS.
California AB 880: “This bill would make it unlawful for a large employer to, among other things…reduce an employee’s hours or work…if the purpose is to avoid the imposition of the penalty. A violation of those provisions would result in a penalty of 200% of the penalty amount the employer would have paid for the applicable period of time.”
ObamaCare’s employer mandate is off to a disastrous start even before it kicks in. The CBO has already scored the measure to cost employers $150 billion in draconian excise taxes over the next eleven years, and there’s no telling how much the compliance costs will total. Most employers are in no position to shoulder this burden. How have they responded? For many, the only hope has been to reduce employees’ hours because the employer mandate and its associated penalty taxes apply only to employees who average at least 30 hours per week. Regal Entertainment Group recently announced that it would join the long line of mega-sized employers to be reluctantly forced down this road.
“Though the earth, and all inferior creatures, be common to all men, yet every man has a property in his own person: this no body has any right to but himself. The labour of his body, and the work of his hands, we may say, are properly his. Whatsoever then he removes out of the state that nature hath provided, and left it in, he hath mixed his labour with, and joined to it something that is his own, and thereby makes it his property.” — John Locke, Second Treatise of Government (1690)
What is “spending through the tax code?” This is an important question in light of the Obama FY 2014 budget proposal finally unveiled last week. We already know it raises taxes by more than $1 trillion. Much of this is done by eliminating so-called “tax expenditures.”
Here is how the Joint Committee on Taxation defines a tax expenditure:
Tax expenditures are defined under the Congressional Budget and Impoundment Control Act of 1974 (the “Budget Act”) as “revenue losses attributable to provisions of the Federal tax laws which allow a special exclusion, exemption, or deduction from gross income or which provide a special credit, a preferential rate of tax, or a deferral of tax liability.”