ObamaCare: Repeal or Repair?

Or simply “tweak” as our friends on the left often glibly opine.  Politically (and practically), repealing the Affordable Care Act might be next to impossible, and it certainly would be terribly divisive at a time when the nation aches for some degree of comity. But the exercise in legislative sausage making that produced the Affordable Care Act and the absurd sweep of regulations that have followed in its wake have produced what is, and what will continue to be, a recurring nightmare for tens of millions of Americans.

Let us acknowledge that many among us for whom health insurance wasn’t available, and who had inadequate access to decent healthcare are certainly better off than they were.  Perhaps these ends would have justified the means had ObamaCare been the only alternative or the best alternative to our healthcare inadequacies. But it was neither the only alternative, nor the best alternative. It was, perhaps, the worst alternative.

A far better alternative would have been to focus solely on the estimated 15% of the population who did not have access to adequate healthcare (more on that in a future essay).  Instead, President Obama was determined to restructure healthcare in America to encompass (or ensnare) 100% of the population, and in so doing, he has crafted what might be the most pervasive and intrusive piece of legislation since the enactment of the Selective Service Act in 1917 or the 16^th Amendment to the Constitution in 1913 which established the federal income tax.  The draft and the income tax were, however, no doubt, necessary.  ObamaCare was not.

The repeal or repair debate is like a national throbbing toothache.  It is like a family buying a very expensive, brand new product and, upon delivery, learning that it doesn’t work as advertised, and that it can’t be returned nor can the price be refunded, but that some people really like it and that everyone else will learn to live with it. That’s about where we are with ObamaCare.

Even the generally supportive New York Times this week reported on the hundreds of thousands of previously Obama-friendly New Yorkers who are up in arms over the policy cancelations and the huge increases in premiums and deductibles with which they are now being saddled.  They are individuals or sole practitioners who through their industry or professional associations had banded together, as had been quite common in the America we once knew, to secure group coverage.  Not anymore though.  Not under ObamaCare.  Too many of these people are healthy and enjoying lower premiums because of their good health, but they are needed in the new ObamaCare exchanges where they will be charged higher premiums in order to subsidize those who are less healthy.

The ObamaCare rationale for disqualifying these policies held by healthy policyholders, according to Larry Levitt of the non-partisan Kaiser Family Foundation, was to prevent associations from selling insurance to healthy members who are needed (by ObamaCare) to keep the new health exchanges financially viable.  The Times even quoted one lifelong Democrat, a liberal New York lawyer, who said had she known what was in store for her, she would have voted for Romney.  Well, she’s not the only person in the country suffering from buyer’s remorse.

All Americans now know that very specific assurances they were given by the President regarding ObamaCare were untrue, and that there is nothing they can do about it – at least not before the next election. No, they aren’t entitled to keep the physician who has cared for them and who they like, and no, they aren’t entitled to keep the health insurance they had which they also liked, and no the President didn’t veto the Affordable Care Act when it added much more than a dime to the deficit as he promised he would.

But wait! (as the Shamwow man used to say on TV) There’s more!  Millions of Americans will also soon learn that if their particular medications are not included in their new insurance company’s formulary they will have to pay the full cost and that cost will not count against their new higher deductibles.  The government’s response? Policyholders can always appeal when their particular insurance company denies coverage of a particular medication. Of course, while such an appeal is pending, the policyholder must pay the full cost or go without the medication.

And then there is the matter of all of the indirect taxes that are imposed on the public in addition to the direct taxes that are spelled out in ObamaCare.  The reader will recall that indirect taxes are the hidden taxes that are directly charged to some entity that produces goods or services and then which are passed on to the public in the price of those goods or services. The consumer never sees a tax bill for indirect taxes, but pays for the tax just the same.

We used to get very exercised over these stealth taxes. Remember the Boston Tea Party?  But now we just sort of yawn and pay them. But ObamaCare has really pushed both direct and indirect taxes onto the public like there’s no tomorrow. Effective, pretty much immediately, are nearly three quarters of a trillion dollars in brand new taxes. Yes, that’s trillion, with a “t”.  American’s will now be shouldering 18 new taxes (and penalties), which the Congressional Budget Office and the Joint Committee on Taxation project will impose $771 billion in new taxes and penalties.  Nearly all of these taxes are now effective, with a few that kick in over the next few years.

This tax frenzy is driven by the very broad reach of ObamaCare. There’s the combination of the huge expansion of Medicaid coupled with a bevy of new government subsidies to pay for insurance coverage in the new government-run state exchanges. These provisions will cost nearly $1.8 trillion over the next ten years.

Next year, Obamacare expands Medicaid to all individuals earning up to 138 percent of the federal poverty level in every state that chooses to participate in this expansion, which will add an additional 13 million Americans to Medicaid by 2023.  This expansion will cost federal taxpayers $709 billion between now and 2023.

ObamaCare then generously provides government subsidies for individuals and families earning between 100 percent and 400 percent of the Federal Poverty Line in order to attract participation. This past year, 400 percent of the Federal Poverty Line was about $46,000 for an individual and $94,200 for a family of four. By 2023, an estimated 19 million people will receive these subsidies, at a cost of over $1 trillion.

An important component of the Affordable Care Act was the assumed reduction in Medicare reimbursements to doctors and hospitals.  A formula designed to annually set the rate that physicians would be reimbursed for taking care of Medicare patients (the Sustainable Growth Rate provision), would have resulted in cuts to doctors year after year, so it has been waved every year out of fear that the cuts would produce an exodus of doctors from the Medicare market.  This week, Congress delayed, for three months, a cut slated for Jan. 1, 2014 of more than 20 percent to physicians who take care of Medicare patients.

Meanwhile, the White House will be holding its collective breath through 2014 waiting to see how many employers, large and small, continue to provide healthcare coverage or simply send their employees to the ObamaCare exchanges where premiums are certain to be higher than those of the current employer-provided plans.

It is certainly questionable whether the Affordable Care Act will ever be repealed or to what extent it can be repaired.  What seems obvious, however, is that it should never been passed in the first place by a congress that didn’t understand it, based on assurances that anyone with any sense should have known were disingenuous political blather…Period!