Archive for June, 2012
The Supreme Court’s Obamacare decision is expected next week, but it’s important to remember that the constitutionality of the law’s individual mandate isn’t the only concern. Several surveys have revealed that doctors have a negative view of the law and its impact on the practice of medicine. Here are five ways Obamacare will harm doctors:
- Adds more patients to Medicaid. Beginning in 2014, Obamacare dumps an additional 19.6 million Americans into Medicaid. On average, Medicaid physician payments are only 56 percent of what private insurance pays. Lower payment rates already discourage doctors from accepting Medicaid beneficiaries, which has lead to access issues and hospital emergency room overcrowding. As more patients enroll in this broken program, it will place even more financial strain on physicians who treat them. Doctors will be faced with the decision to either discontinue treating Medicaid patients or accept even more patients at the lower payment rate.
Obamacare’s massive Medicaid expansion—combined with its new system of subsidies for government-defined coverage for additional millions of Americans—will force 29.4 million Americans to move from one form of health coverage to another each year, a recent study shows.
The effect, called “churning,” is the involuntary movement of individuals from one type of coverage to another. While some churning existed before Obamacare, the health law makes the problem much worse, making continuous coverage less likely for many Americans.
New research by the Robert Wood Johnson Foundation and the Urban Institute concludes that 29.4 million Americans under the age of 65 will be forced to change their coverage from year to year under Obamacare. That represents 31 percent of the estimated 95.9 million people that will either be in Medicaid or receive subsidies in the exchanges in any given year.
Once, Obamacare’s defenders were certain the Supreme Court would uphold the individual mandate requiring every citizen to purchase health insurance. Then came the oral argument. Solicitor General Donald Verrilli was unable to articulate a limiting principle to Congress’s powers. That set off a scramble to find historical precedent for the individual mandate.
Enter Law professor Einer Elhauge. He’s “discovered” three Founding-era purchase mandates supposedly similar to the Obamacare mandate: the 1790 act to regulate commercial ships, the 1792 militia act, and the 1798 act creating a fund for sick seamen. However, none of these laws sets a precedent for the federal government to require every individual to purchase health insurance.
The 1790 act regulated all ships engaged in foreign commerce and large ships engaged in domestic commerce. Most of the regulations addressed contract disputes, desertion, and what recourse the crew had if the vessel was unsafe. It detailed penalties for sailors and captains who failed to comply with the regulations.
Days before the U.S. Supreme Court is set to rule on the constitutionality of Obamacare, liberals in Congress are laying the groundwork to preserve some of the law’s badly flawed provisions that happen to poll well with voters.
Rep. Jim Jordan (R-OH), chairman of the Republican Study Committee, said conservatives should focus on another goal: repealing all of Obamacare.
Recent reports indicate that provisions addressing pre-existing conditions, coverage for dependents up to age 26 and the Medicare prescription drug “donut hole” — each of which enjoys some support in polls — could become the focus of congressional action if the Supreme Court strikes down the law.
In remarks today at Heritage’s Bloggers Briefing, Jordan said that would be misguided:
We should repeal all of Obamacare and restart the whole debate — and not focus on Washington as the so-called answer to health care, but focus on market solutions. It’s really that basic. We want to empower families, we want to empower moms and dads, we want to empower individuals to make their health-care decisions.
Unless President Obama and Congress take action soon, Taxmageddon will hit on January 1, 2013. Taxmageddon is a $494 billion tax increase for 2013 alone. It is made up of several expiring tax policies and the implementation of new Obamacare tax increases that all kick in at the start of next year.
Five of Obamacare’s 18 new taxes begin in 2013, and they would raise $23 billion for the year. Heritage tax policy expert Curtis Dubay explains that two of them will be especially harmful: an increase in the Medicare payroll tax and a new medical device tax.
Starting January 2013, Obamacare increases the Medicare payroll tax from 2.9 percent to 3.8 percent for individuals with income over $200,000 a year ($250,000 for couples). This increase will hinder economic growth and deter job creation for small businesses.
In anticipation of the Supreme Court’s Obamacare decision, it is important to remember that the constitutionality of the law’s individual mandate isn’t the only concern. For example, Obamacare will negatively impact many younger Americans. Here’s a list of five ways young adults will be hurt by the law:
- Premium increases. Obamacare imposes age-rating rules that increase premiums for young adults. The law allows premium costs to vary by a ratio of 3 to 1 based on age. But as Heritage research shows, “The natural variation by age in medical costs is about 5 to 1—meaning that the oldest group of (non-Medicare) adults normally consumes about five times as much medical care as the youngest group.” This means that under Obamacare, young adults will pay artificially high premiums, and older adults will pay artificially low premiums. Actuaries estimate that “the effect will be to increase premiums for those ages 18–24 by 45 percent and those ages 25–29 by 35 percent while decreasing premiums for those ages 55–59 by 12 percent and those ages 60–64 by 13 percent.”
- Loss of coverage. Obamacare puts in place new rules that prohibit plans with annual limits. While limited health plans may not be a long-term solution, some coverage is still better than none. Several colleges across the country have already stopped offering low-cost plans to students because of the new regulations.
As the nation awaits the Supreme Court’s ruling on Obamacare, much attention has been paid to the constitutional questions surrounding the individual mandate—and rightly so. Considerable attention has also focused on the ways Obamacare has already and will further harm our nation’s health care and how it has trampled religious liberty. But we shouldn’t forget something even more fundamental to justice: Obamacare is hostile to life, and it set a new precedent by federally subsidizing abortion.
An article by Bill Saunders and Anna Franzonello in the Notre Dame Journal of Law, Ethics, and Public Policy explains the health law’s shift in federal abortion policy. Prior to the passage of Obamacare, long-standing policy was that federal tax dollars were not to be used to pay for abortion or to pay for plans that cover abortions. As they note: “At the time of the health care reform debate, no government health plans covered elective abortion, including Medicaid, the Federal Employees Health Benefits Program, the State Children’s Health Insurance Program, and other programs. The ‘status quo’ prior to the PPACA was that federal tax dollars are not used to pay for abortion nor for insurance plans that cover abortions.”
The Centers for Medicare and Medicaid Services Office of the Actuary (OACT) just released its projections for national health spending through 2021. The picture isn’t pretty, as health spending will continue to increase at a much faster rate than the gross domestic product (GDP), consuming 19.6 percent (almost one-fifth) of the nation’s economy in 2021.
Growth in health spending will remain modest until 2014, when Obamacare expands Medicaid to an additional 19.6 million Americans and creates exchanges to regulate private insurance and administer new federal subsidies. Once these changes go into effect, Medicaid spending will increase by 18 percent, and private health insurance spending will increase by 7.9 percent, since more people will gain coverage through the government-run exchanges. According to OACT, “Together, Medicaid and private health insurance spending contribute to an overall acceleration in projected national health spending growth to 7.4 percent, which is 2.1 percentage points faster than would be expected in the absence of health reform.”
The Obama Administration clearly chose to wear rose-tinted glasses to interpret the projections. In an interesting twist on the CMS report, Secretary of Health and Human Services (HHS) Kathleen Sebelius touts “No increase in national health spending as a percent of GDP for five years.” But the Secretary backdates the projections, going on to say, “From 2009 through 2013, national health spending will not increase as a percent of the economy.” Of course, she knows that the major provisions of Obamacare don’t begin until 2014.
Students at Roosevelt High School in Los Angeles can now swing by Planned Parenthood on the way to study hall to pick up their “free” birth control. While they may need a permission slip to get out of class, nothing of the sort is required to access the pill, the patch, the ring, or the shot per California law. As the Los Angeles Times reports, a chapter of Planned Parenthood—the largest provider of abortion services in the nation (and as we found out a couple weeks ago, sex-selective abortions are included)—has made a home on the school’s campus.
As the Times notes, “although nonprofit groups frequently offer reproductive healthcare on school campuses around the nation, the partnership involving Planned Parenthood…is the only one of its kind.”
This one-of-a-kind partnership is also operating to recruit “student advocates” who will reach out to their peers and “try to get them on birth control,” as one Roosevelt teen explains.
More than 80 plaintiffs in 23 different lawsuits are now challenging the HHS mandate that will require many religious institutions to provide health insurance coverage for abortion-inducing drugs, sterilization, and other contraceptive services. At the heart of these lawsuits is whether the government’s purported interest in marginally increasing access to contraceptive services trumps the basic right to religious liberty that both individuals and institutions have traditionally enjoyed.
The First Amendment states that “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof…” The institutions challenging the HHS mandate argue that it violates their right to free exercise because the mandate forces them to provide coverage for contraceptive services that conflict with their religious beliefs. HHS is allowing exemptions from the mandate for institutions that have as their primary purpose the inculcation of religious values and that mainly employ and serve people sharing the same religious beliefs as the institution. Essentially churches would appear to be the only religious institutions that meet HHS’s narrow definition of a “religion employer.” As Rev. Larry Snyder, President of Catholic Charities USA, has quipped, it is doubtful that the ministry of Jesus Christ would have qualified for HHS’s narrow definition of exempted religious services.
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