Barack Obama is celebratory once again in the wake of another Supreme Court vote in favor of his monstrosity known as Obamacare. In the wake of this victory for him and his socialist wrecking ball of a law, he uttered a now-familiar phrase: the Affordable Care Act is “here to stay“.
I find the phrase to be Orwellian not because it is more a wish of his than an actual fact, but because Barack Obama has unilaterally (and unconstitutionally) thwarted the full implementation of the law almost since its first passage; that is, Obamacare has yet to fully be here, in all its ugliness, and so it cannot be said to be here to stay.
Employer Mandate Delays
Principal among these delaying actions was Obama’s suspension of the so-called Employer Mandate, which he has done multiple times. Why has he done this again and again? Because the Employer Mandate forces American businesses with greater than 50 employees to offer government-approved health insurance or else pay substantial fines.
There are so many problems with this (and unintended consequences, including that companies with 49 or 50 employees plan to stop hiring) that I won’t mention them all here. Suffice it to say, federal bureaucrats expect the fines to generate $10 billion for Leviathan, all at the expense of private companies who employ the nation.
Will Americans agree that “Obamacare is working” once this mandate hits businesses and their employees?
Cadillac Tax: 2017 implementation
The real destruction to our nation’s health insurance system will come when the so-called Cadillac Tax kicks in in 2017. This provision in my opinion is one of the most sadistic and cruel legislative acts in our nation’s history, particularly considering the spiteful motivation behind it and its lack of any redeeming qualities.
The Cadillac Tax, designed by Jonathan Gruber and John Kerry on behalf of Barack Obama, will levy a 40% tax on the most lucrative, wonderful health insurance plans offered to workers by private employers. That’s right, Obamacare stands for the destruction of above-average health plans that have been available to tens of millions of Americans for years and years, and it is easy to see why mr. Obama elected to launch it in 2017, a year after he will have left office.
Will Americans agree that “Obamacare is working” once this cruel tax hits businesses and their employees?
Independent Payment Advisory Board: Obama has yet to nominate anyone…
The IPAB is to be a 15-member star chamber of central government bureaucrats who will have sole authority to beat down the Medicare system, taking decisions out of the hands of doctors and patients, and even elected representatives in Congress, all in the name of “controlling health care costs”.
The IPAB is so draconian and smacks so much of fascism that even Democrats want it removed from the Affordable Care Act (see Even Barney Frank Knows It’s Wrong and Hates it).
The ACA called for this group of high priests to start wielding power over our senior citizens beginning in 2011, and yet it has never been convened, and its members never named by Barack Obama.
…even after the Senate changed its rules to require only 51 votes to confirm presidential appointees, the President never nominated any IPAB members. <Commonwealthfund.org, link)
Because it is the same as all the other deadly provisions of Obamacare: so bad that if Americans actually experienced it, they would vote to have even more Republicans in Congress and perhaps one in the White House in order to take back control over their bodies and their lives. Barack Obama knows this, and so pursues a slow suffocation of all of us, claiming that “Obamacare is here to stay” and that “…it is working…”.
It is not working, and when it finally achieves full implementation, the extraordinary pain and suffering inherent in the law will descend upon nearly all 270 million Americans who were happy with their health care in the years prior to 2010.
But by then, Obama’s thinking goes, it will be too late to reverse it, and the forces of central power will be fully ensconced in their ivory tower, lording over our health and well-being like so many kings in the year 1150 AD, before the Magna Carta and long before representative government.
Oh, and did I forget to mention that the federal government exempted itself from Obamacare?
Of course it did — this is how tyranny works.
Here is a long list of Obama’s intentional, unilateral, slowing-down of the law’s provisions, excerpted from a helpful article at Galen Institute (link). If you have the patience to read through this long list, you will experience the full reality of how Barack Obama has deliberately prevented the truth of Obamacare’s consequences from being known.
Changes By Administrative Action
1.) Employee reporting: The IRS announced that, contrary to statutory language, it was delaying the ACA requirement that employers must report to their employees on their W-2 forms the full cost of their employer-provided health insurance. (March 29, 2011)
2.) Medicare Advantage patch: The administration ordered an advance draw on funds from a Medicare bonus program to provide payments to Medicare Advantage plans to temporarily forestall payment cuts called for in the ACA that could have led to cuts in benefits and an early exodus of MA plans from Medicare. (April 19, 2011)
3.)Tax credit subsidies for some people under 100% FPL and for unlawful immigrants: The ACA provides refundable tax credits to U.S. citizens with incomes between 100 and 400% of poverty, but IRS regulations give credits to citizens below 100% FPL in some cases. Also, Section 36B of the ACA grants credits to some non-citizens with low-incomes only if they are themselves lawfully present in the U.S. and cannot obtain Medicaid coverage. IRS regulations contradict the statute and allow subsidies if “the taxpayer or a member of the taxpayer’s family is lawfully present in the United States,” and “the lawfully present taxpayer or family member is not eligible for the Medicaid program.” (August 17, 2011)
4.) Subsidies may flow through federal exchanges: The IRS issued a rule that allows premium assistance tax credits to be available in federal exchanges although the law specified that they only would be available through an “Exchange established by the State.” (May 23, 2012)
5.) Extension of credits to people receiving employer-sponsored coverage. Section 1511 of the ACA instructs the Labor Department to issue regulations requiring businesses with more than 200 employees to automatically enroll their employees in any health benefits plan offered by the employer. Section 36B correspondingly denies credits to employees covered by an employer plan. IRS regulations contradict the statutory language and allow credits to taxpayers when they are automatically enrolled in employer minimum essential coverage. Treasury implicitly acknowledges there is no statutory authority for its regulatory change. (May 23, 2012)
6.) Delaying a low-income plan: The administration delayed implementation of the Basic Health Program until 2015. It would have provided more-affordable health coverage for certain low-income individuals not eligible for Medicaid. (February 7, 2013)
7.) Closing the high-risk pool: The administration decided to prematurely halt enrollment in transitional federal high-risk pools created by the law, blocking coverage for an estimated 40,000 new applicants, citing a lack of funds. The administration had money from a fund under HHS Secretary Sebelius’s control to extend the pools, but instead used the money to pay for advertising for Obamacare enrollment and other purposes. (February 15, 2013)
8.) Doubling allowed deductibles: Because some group health plans use more than one benefits administrator, plans were allowed to apply separate patient cost-sharing limits to different services, such as doctor/hospital and prescription drugs, allowing maximum out-of-pocket costs to be twice as high as the law intended. (February 20, 2013)
9.) Small businesses on hold: The administration said federal exchanges for small businesses will not be ready by the 2014 statutory deadline, and instead delayed until 2015 the provision of SHOP (Small-Employer Health Option Program) that requires exchanges to offer a choice of qualified health plans. (March 11, 2013)
10.) Employer-mandate delay: By an administrative action that is contrary to language of the ACA, enforcement and reporting requirements for the employer mandate were delayed by one year until 2015. (July 2, 2013)
11.) Self-attestation: Because of the difficulty of verifying income after the employer-reporting requirement was delayed, the administration it would allow “self-attestation” of income and eligibility by applicants for health insurance in the exchanges. (July 15, 2013)
12.) Congressional opt-out: The administration decided to offer employer contributions to Members of Congress and their staffs when they purchase insurance on the exchanges created by the ACA, a subsidy the law doesn’t provide. (September 30, 2013)
13.) Delaying the individual mandate: The administration changed the deadline for the individual mandate by declaring that customers who purchased health insurance by March 31, 2014, would avoid the tax penalty. The law says they would have had to purchase a plan by mid-February to avoid penalties. (October 23, 2013)
14.) Insurance companies may offer canceled plans: The administration announced that insurance companies may reoffer plans that previous regulations had forced them to cancel. (November 14, 2013)
15.) Delaying the online SHOP exchange: The administration first delayed for a month and later for a year until November 2014 the launch of the online insurance marketplace for small businesses that originally was scheduled to launch on October 1, 2013. (September 26, 2013) (November 27, 2013)
16.) Exempting unions from reinsurance fee: The administration gave unions an exemption from the reinsurance fee. To make up for this exemption, non-exempt plans will have to pay a higher fee, which will likely be passed onto consumers in the form of higher premiums and deductibles. (December 2, 2013)
17.) Extending Preexisting Condition Insurance Plan: The administration extended the federal high risk pool until January 31, 2014 and again until March 15, 2014 to prevent a coverage gap for the most vulnerable. The plans were scheduled to expire on December 31, but were extended because it has been impossible for some to sign up for new coverage on healthcare.gov. (December 12, 2013) (January 14, 2014)
18.) Expanding hardship waiver to those with canceled plans: The administration expanded the hardship waiver – which exempts people from the individual mandate and allows some to purchase catastrophic health insurance – to people who have had their plans canceled because of ObamaCare regulations. The administration later extendedthis waiver until October 1, 2016. (December 19, 2013) (March 5, 2014)
19.) Bay State bailout: More than 300,000 people in Massachusetts gained temporary Medicaid coverage in 2014 without verification of eligibility, with the Obama and Patrick administrations using a taxpayer-funded bailout to mask the failure of the commonwealth’s disastrously malfunctioning website. (January 2014)
20.) Equal employer coverage delayed: Tax officials will not be enforcing in 2014 the mandate requiring employers to offer equal coverage to all their employees. This provision of the law was supposed to go into effect in 2010, but IRS officials have “yet to issue regulations for employers to follow.” (January 18, 2013)
21.) Employer-mandate delayed again: The administration delayed for an additional year provisions of the employer mandate, postponing enforcement of the requirement for medium-size employers until 2016 and relaxing some requirements for larger employers. Businesses with 100 or more employees must offer coverage to 70% of their full-time employees in 2015 and 95% in 2016 and beyond. (February 10, 2014)
22.) Extending subsidies to non-exchange plans: The administration released a bulletin through CMS extending subsidies to individuals who purchased health insurance plans outside of the federal or state exchanges. The bulletin also requires retroactive coverage and subsidies for individuals from the date they applied on the marketplace rather than the date they actually enrolled in a plan. (February 27, 2014)
23.) Non-compliant health plans get two year extension: The administration pushedforward by two years the deadline requiring health insurers to cancel plans that are not compliant with ACA mandates. These “illegal” plans can be offered until 2017. This extension prevented a wave of cancellation notices from going out before the 2014 midterm elections. (March 5, 2014)
24.) Reducing cost sharing reductions. The ACA calls for out-of-pocket maximums to be lowered for enrollees with incomes between 100-400% FPL (Sec. 1402), but the provision proved unworkable for those 250-400% of FPL in combination with prescribed actuarial value requirements. The law was changed through regulation to apply to only those 100-250% of poverty. (March 11, 2014)
25.) Delaying the sign–up deadline: The administration delayed until mid-April the March 31 deadline to sign up for insurance without penalty. Applicants simply need to check a box on their application to qualify for this extended sign-up period. (March 26, 2014)
26.) Canceling Medicare Advantage cuts: The administration canceled further scheduled cuts to Medicare Advantage. The ACA calls for $200 billion in cuts to Medicare Advantage over 10 years. (April 7, 2014)
27.) More Funds for Insurer Bailout: The administration said it will supplement risk corridor payments to health insurance plans with “other sources of funding” if the higher risk profile of enrollees means the plans would lose money. (May 16, 2014)
28.) Exempting U.S. territories: Despite earlier administration claims that “HHS is not authorized to choose which provisions [of the ACA] might apply to the territories,” HHS waived six major requirements – such as guaranteed issue, community rating, and essential benefit mandates – that were causing serious disruption to health insurance markets covering 4.5 million residents of U.S. territories. (July 18, 2014)
29.) Failure to enforce abortion restrictions. A GAO report found that many exchange insurance plans don’t separate charges for abortion services as required by the ACA, showing the administration is not enforcing the law. In 2014, abortions were being financed with taxpayer funds in more than 1,000 exchange plans. (Sept. 16, 2014)
30.) Risk Corridor coverage: The Obama administration plans to illegally distribute risk corridor payments to insurers, despite studies by both the Congressional Research Service and the GAO saying a congressional appropriation is required before federal agencies can make the payments. (Sept. 30, 2014)
31.) Transparency of coverage: CMS delays statutory requirements on insurance companies to disclose data on the number of people enrolled, disenrollment, number of claims denied, costs to consumers of certain services, etc. (Oct. 20, 2014)
32.) Tax penalty pass: Taxpayers who filed returns based upon inaccurate subsidy data they received from the federal government will not have to repay the government if they received too large of a subsidy, the IRS ruled. (February 24, 2015)