Nancy Pelosi, the Speaker of the House of Representatives who shepherded the Patient Protection and Affordable Care Act through her chamber in 2009 and 2010, once famously said that we need to pass the bill so that we can find out what’s in it. Fair enough; now that it has passed, here’s a sample of what’s in it:
· The HHS now has authority over all physicians and their decisions, even if they are treating patients in private practice and/or under private insurance plans having nothing to do with Medicare or Medicaid.
· Citizens who fail to enroll in a health insurance plan approved by the Secretary of the Department of Health and Human Services (HHS) will be fined: $285 in 2014; $975 in 2015; $2,085 in 2016. Your current plan may not qualify for approval, especially if it is a low-premium, high-deductible plan. See Section 1501 of the law.
· The IRS will withhold income tax refunds from taxpayers who fail to prove that they are enrolled in an HHS-approved plan.
· Employers of 50 or more full-time employees must provide an HHS-approved health plan or pay a fine of $2000 for each employee beyond the thirtieth.
· $716 billion will be siphoned out of Medicare to pay for Obamacare.
· Capital gains taxes (like the one that hits you when you sell your house after a lifetime of paying your mortgage on time) go up 3.8 percent on gains over $200,000.
· A 40% tax on high-end ‘Cadillac’ health care plans.
· No more low-premium, high-deductible plans allowed. Mini-Med plans such as the ones offered by McDonald’s to entry-level workers, are now history.
· New limits on tax deductions for medical expenses. The threshold is now 10 percent of your income instead of 7.5 percent.
· The law creates the Independent Payment Advisory Board, or IPAB. The Board’s decisions may only be overruled by Congress with a 60 percent supermajority in the Senate. Until the board is seated, the Secretary of the Department of Health and Human Services (Kathleen Sibelius) wields the board’s authority.
· You will have to tell your boss how much money your spouse and children earn. Your employer is required by law to collect information about your total household income in order to classify you in the right ‘affordability’ category.
· Tax-free contributions to Flexible Spending Accounts or FSAs are capped at $2,500. Likewise, the use of Health Savings Accounts (HSAs) is restricted and deductibles are capped at $2,000 for individuals, $4,000 for families. These accounts may no longer be used to pay for over-the-counter drugs. Tax penalties for non-allowable purchases made through these accounts increase from 10 to 20 percent.
· The Medicare Part A payroll tax is hiked for taxpayers (like job-creating small business owners) who earn more than $200,000 individually or $250,000 as a couple.
· Funding for Medicare Advantage is to be cut 27%. Each of its 7 million currently covered seniors will get on average $3,700 less allowance per year.
· Spending to staff the government health care bureaucracy is expected to more than double to over $70 billion by the year 2020.
· Waivers: 1600 (and counting) special privileges of exemption from compliance with Obamacare’s mandates have been awarded disproportionately to unions and groups that supported Obama’s political agenda. The waivers weren’t written in the law, but they have become part of the policy implementation since the law passed. So finding out what’s in it includes finding out that privileges, prejudices and enforcement will be arbitrary and based on political favoritism.
· People who don’t get health coverage from their employer or from traditional government programs like Medicare and Medicaid are expected to shop for it at subsidized rates on ‘exchanges’ sponsored by the law, starting in 2014. Half of the states have so far refused to do the federal government’s bidding, so presumably the federal government will set up them on its own in those states. Companies that offer health insurance to their employees will nevertheless be fined for failing to provide adequately if their employees opt for shopping on the exchanges.
· …and a whole lot of other stuff contained in its 2,500+ pages that none of the congressmen who voted on it read in its entirety.
Even though the law itself is comprised of over 2,500 pages of legalese, administrative departments like HHS still have the task of interpreting the law and writing the derived regulations that companies, individuals, patients and doctors are supposed to comply with. That will multiply the volume several times over.
Many of the nicest people you will ever meet supported the bill with the best of intentions, including most of this author’s family and social circle. But if every senator and representative in Congress – and the citizens who voted for them – had known that all of the above was in the bill, would it have passed?