The Patient Protection and Affordable Care Act was to be the crowning achievement of President Obama when he signed it into law March 23, 2010. Although the first drafts of the bill were more than 2,000 pages, the final bill signed into law was reported to have more than a million words on 906 pages. Estimates of regulations and rules amount to an estimated 13,000 to 33,000 pages that must be administered by 159 new agencies, boards and programs.
The healthcare law that is being phased in is so convoluted that corporate legal departments need assistance. An attorney who is general counsel for a healthcare firm stated that outside legal advice is needed because the changes are coming so fast and no one knows the answers to the questions that arise. Speaking on April 17 this year, Senator Max Baucus (D-Montana) said implementation would be a ‘giant train wreck.’ Baucus was the Senator selected to manage the bill’s progress through Congress.
Here are some hurdles to surmount: The President claimed the deceptively named Affordable Care Law would cost about $900 billion but is now expected to cost $1.8 trillion or double the original estimate. Costs of insurance are now spiraling upward considering that pre-existing conditions must be covered and companies must provide for the addition of same-sex married couples in many states. The employer mandate (companies with 50 or more employees) must provide coverage for full time workers or pay a fine. (This provision has been postponed one year to January 1, 2015.) It is uncertain how many employers will pay the fine and employees will seek coverage in the state ‘marketplace’ or ‘exchange.’
However, the state exchanges have been vetoed in some states and have been delayed in others. Firms with young healthy workers will see insurance costs skyrocket to accommodate the premiums of companies with mostly elderly employees. By utilizing part-time workers, employers (including state and local governments) can opt out of healthcare coverage completely, requiring workers to find insurance on the ‘exchange.’ The CBO estimates that there will be about 30 million people without coverage by 2019.
Complicated requirements in the bill raise many concerns. Both doctors and hospitals will be rated on their efficiency. These are subjective evaluations that can lead to abuse by inflating or reducing ratings. An almost certain shortage of physicians is predicted, in part because many are retiring now to avoid working with the bureaucratic red tape of Obamacare. The pool of healthy young people may prefer to pay the fines than the high premiums. One of the most grisly provisions of Obamacare is the ‘Independent Payment Advisory Board’ (IPAB) without clear accountability and called by some ‘A Death Panel.’
Healthcare now represents nearly 18% of GDP and is going to grow almost double the rate of the Consumer Price Index (CPI). There are limited common sense provisions for market-based pricing and operations. A 2009 report says that more than 4,525 lobbyists representing 1,750 companies helped create this monster bill behind closed doors. Trusting voters believed the hype and it became law on the prophetic (pathetic?) words of then Speaker of the House Nancy Pelosi, “We have to pass the bill to find out what is in it.”
Not only is the current healthcare law cumbersome and adding to the national debt, but Medicare, graduate school for Obamacare, has unfunded liabilities amounting to $86 trillion, more than 5 times annual GDP of $15.7 trillion. Would it be crass to suggest that the reason our political leaders are indifferent to the approaching inexorable fiscal exigency is that Congress sets their own irrevocable salaries, healthcare and retirement benefits? Is it possible that the President, living in subsidized housing with airplanes, helicopters and protective limousines at his disposal enjoying incomparable benefits until death, accepts no accountability? Think it over.
