Source: https://chrisjacobshc.com/2013/11/
Timestamp: 2019-04-22 00:11:40+00:00

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We wrote earlier this week about the ways Obamacare discourages marriage and work. These aren’t the only traditional values it undermines.
Obamacare goes against two values that should be no-brainers: prioritizing American citizens over non-citizens, and prioritizing help for the disabled over assistance for able-bodied adults.
Obamacare includes special provisions that allow many legal, non-citizen residents to qualify for federally subsidized insurance and, in so doing, offers these non-citizens more and better coverage options than American citizens.
The law as implemented creates two inequities that put American citizens at a disadvantage compared with non-citizens.
First, in states that expand their Medicaid programs, citizens with incomes under 138 percent of the federal poverty level will be automatically enrolled into Medicaid, while non-citizens will receive subsidies to purchase coverage in the Obamacare exchange.
Several studies show that patients with Medicaid coverage have worse outcomes than the uninsured, and some Medicaid beneficiaries do not consider the program “real insurance.” Yet Obamacare dumps millions of American citizens into this troubled program, even as it grants many non-citizens the opportunity to pick health plans of their choosing.
Second, in states that do not expand their Medicaid programs, non-citizens will be able to purchase subsidized health insurance in the exchanges, while American citizens below 100 percent of the poverty line may not qualify for subsidized coverage at all.
It simply doesn’t make sense to offer non-citizens more and better coverage options than American citizens. This potentially encourages immigration to the United States by those seeking to benefit from taxpayer-funded welfare programs, which increases the incentives for people not to become citizens, and thus full, integral members of our civic society.
A public safety net is necessary for those truly in need. But by spending more than $700 billion on its massive Medicaid expansion, Obamacare puts a greater emphasis on covering able-bodied adults than the disabled, which Medicaid was originally intended to serve.
By extending health coverage to those who should be able to work, Obamacare could jeopardize the coverage of disabled Americans. And by subsidizing health coverage for millions of unemployed and underemployed, Obamacare could accelerate the development of a permanent underclass that has little financial incentive to work.
Given its poor outcomes for patients, Medicaid needs significant changes. However, true reform cannot come from adding able-bodied adults to an already overburdened program. Instead, Congress should focus on improving Medicaid’s quality of care, while restoring its emphasis on providing a safety net for the truly needy.
This post was originally published at The Daily Signal.
We were told that Obamacare was supposed to be compassionate toward the needy in America.
While President Obama and his fellow liberals may have held the best of intentions while ramming Obamacare through Congress, the law’s policies are far from compassionate toward the uninsured and Americans with low and modest incomes.
In fact, the law perpetuates some of the country’s worst trends that trap people in poverty. It includes disincentives for individuals to marry and for Americans of low and modest incomes to work. Discouraging work and marriage will only perpetuate poverty and income inequality, not alleviate them.
The way Obamacare calculates federal premium subsidies and cost-sharing subsidies includes several “cliffs.” A person might qualify for a hefty subsidy at his current income, but if he gets a raise and makes a little more, that Obamacare subsidy disappears.
At these cliffs, individuals and families will actually benefit more by working less because additional earnings could cause them to lose thousands of dollars in taxpayer-funded subsidies.
Families facing these kinds of poverty traps may ask the obvious question: If I will lose so much in government benefits by earning additional income, why work?
Rather than encouraging hard work, initiative, and entrepreneurship, Obamacare instead undermines these essential American values.
Obamacare contains not one, but two penalties on marriage—one for families with low and moderate incomes and another for families with higher incomes. By continuing failed policies that undermine the institution of marriage, Obamacare will accelerate a root cause of income inequality in the United States.
Here’s an example. A 50-year-old non-smoker making $35,000 per year would qualify for a sizable insurance subsidy, according to the Kaiser Family Foundation’s insurance subsidy calculator. The individual’s premium would be capped at 9.5 percent of income, resulting in an insurance subsidy of $2,065 paid by the federal government.
However, if this 50-year-old is married to another 50-year-old who also makes $35,000 per year, the couple would receive no insurance subsidy at all. This couple would incur a marriage penalty of $4,130 in one year—equal to the $2,065 that each individual could have received if they were not married.
Obamacare sends a clear message that reliance on government is preferable to these traditional American values—work and marriage.
Our health care policy should not be undermining these foundations of society. For a more commonsense approach to health care reform, check this out.
A PDF of this Backgrounder is available on the Heritage Foundation website.
”We are a compassionate nation,” President Barack Obama recently stated in his weekly radio address, talking about the health care law—implying that critics of Obamacare are not. Nothing could be further from the truth. Obamacare itself is an uncompassionate law.
While President Obama and his fellow liberals may have held the best of intentions while ramming Obamacare through Congress, the law’s policies are far from compassionate toward the uninsured and Americans with low and modest incomes. Obamacare discourages work, penalizes marriage, places citizens at a disadvantage compared with non-citizens, and prioritizes coverage for able-bodied adults over services and supports for the disabled.
To restore the values of hard work that Americans have held dear for centuries, Congress should repeal all of Obamacare. Further, Congress should reexamine other tax and welfare policies with an eye toward encouraging work and marriage.
Many of Obamacare’s flaws are well known. According to the Congressional Budget Office (CBO), the law will spend nearly $1.8 trillion over the next 10 years on new insurance subsidies and an expanded Medicaid program. However, inherent design flaws in that subsidy regime will create winners and losers in a way that penalizes both work and marriage and that prioritizes the able-bodied over the disabled and citizens over non-citizens.
Rather than “spreading the wealth around” as then-Senator Obama famously discussed during his 2008 campaign, Obamacare will actually concentrate wealth. By penalizing work, the law fundamentally acts as a brake on low-income and middle-income families’ desire to prosper. Instead of improving their prospects to succeed, Obamacare focuses solely on making their current status less bleak. The American people deserve better than Obamacare’s dystopian vision.
Many of the inequities present in Obamacare stem from Section 1401 of the law, which establishes eligibility for subsidized insurance in government-run exchanges. Obamacare’s formulae for allocating federal premium and cost-sharing subsidies include several “cliffs.” At these cliffs, individuals and families will actually benefit more by working less because additional earnings could cause them to lose thousands of dollars in taxpayer-funded subsidies.
For example, Obamacare subsidizes insurance premiums for individuals with incomes of up to 400 percent of the federal poverty level (FPL), which is just over $62,000 for a couple in 2013. According to the Kaiser Family Foundation’s subsidy calculator, a married couple, each 50 years old, making a combined $60,000 per year would receive a taxpayer-funded insurance subsidy of up to $5,081. The couple would qualify for this subsidy because their combined income would be just below 400 percent of the FPL. However, if the couple earned an additional $2,500—raising their income just above 400 percent of the FPL—they would receive no subsidy at all. Even though they receive $2,500 more in cash compensation, the couple would actually be worse off financially because they would lose more than $5,000 in federal insurance subsidies.
Similar cliffs occur elsewhere in Obamacare’s subsidy structure. As income approaches 400 percent of the FPL, the percentage of income that households are expected to devote to insurance premiums rises, and the premium subsidies under Section 1401 fall. Individuals with rising income also face the loss of federal cost-sharing subsidies established under Section 1402 of the law, which reduce out-of-pocket expenses including co-payments and deductibles. These effects are particularly acute at certain cliffs established in the statute—for instance, 150 percent, 200 percent, and 250 percent of the FPL—but they also pervade the entire subsidy structure. Overall, University of Chicago economist Casey Mulligan has concluded that Obamacare will help raise effective marginal tax rates by more than 10 percentage points.
With no work at all this family generates $14,000 in benefits. If it earns poverty level income of about $17,000, its total income would rise to about $26,700, or close to $13,000…. However, if the family earns about twice the poverty level, or an additional $17,000, income would rise by only about $6,900—an effective average marginal tax rate of about 60 percent, to which must be added any loss of health insurance benefits.
Obamacare will only worsen the poverty trap created by existing programs. By expanding exchange insurance subsidies to those making up to 400 percent of the FPL, the law effectively raises marginal tax rates for a wide swathe of Americans. The law gives millions of Americans new incentives not to work—or not to raise their income levels—because they may lose federal insurance subsidies. According to the most recent Census data, nearly 64 percent of the non-elderly population lives in households below 400 percent of the FPL. These individuals could face the work disincentives created by Obamacare’s new insurance subsidy structure.
The Congressional Budget Office agrees that Obamacare will reduce work incentives by raising marginal tax rates. In a report released shortly after the law’s enactment, the nonpartisan CBO concluded that Obamacare “on net will reduce the amount of labor used in the economy … primarily by reducing the amount of labor that workers choose to supply.” The CBO found that the Medicaid expansion and exchange insurance subsidies “will encourage some people to work fewer hours or to withdraw from the labor market” to remain eligible for taxpayer-funded insurance subsidies. Furthermore, “the phaseout of the [insurance] subsidies as income rises will effectively increase marginal tax rates, which will also discourage work.” CBO Director Doug Elmendorf testified before Congress that Obamacare would reduce the labor supply by about 800,000 workers.
At a time when 5.7 million fewer Americans are looking for work than when the recent economic recession began in December 2007, Obamacare will reduce the size of the labor force even further. The law’s subsidy formula leads to perverse outcomes: “[A]s an individual makes more money, they are rewarded by losing subsidies.” Rather than encouraging hard work, initiative, and entrepreneurship, Obamacare instead undermines these essential American values.
Obamacare contains not one, but two penalties on marriage—one for families with low and moderate incomes and another for families with higher incomes. The first is in its eligibility definitions for insurance subsidies in Section 1401, which sets eligibility based on federal poverty level guidelines. However, because the FPL for a couple is less than twice that for a single person, a married household will remain at an inherent disadvantage compared with two single individuals or an unmarried, cohabiting couple.
A hypothetical example illustrates the nature and scope of the marriage penalties in Obamacare. A 50-year-old non-smoker making $35,000 per year would qualify for a sizable insurance subsidy, according to the Kaiser Family Foundation’s insurance subsidy calculator. The individual’s premium would be capped at 9.5 percent of income, resulting in an insurance subsidy of $2,065 paid by the federal government. However, if this 50-year-old is married to another 50-year-old who also makes $35,000 per year, the couple would receive no insurance subsidy at all. This couple would incur a marriage penalty of $4,130 in one year—equal to the $2,065 that each individual could have received if they were not married.
Obamacare imposes a second marriage penalty that is related to its “high-income” tax. The law creates a new 0.9 percent tax on wage income and 3.8 percent tax on unearned income that exceeds preset thresholds. In both cases, the thresholds for the tax are at $200,000 for a single individual, but $250,000 for a couple. As with the insurance subsidy formula, this new tax will automatically penalize married couples because the tax threshold for couples is less than twice the threshold for single individuals.
As with these subsidy calculations, the marriage penalties from the high-income tax could also be substantial. Two individuals who are each earning wage incomes of $195,000 would fall under the $200,000 threshold for single filers and would therefore not incur any additional liability under Obamacare. However, if these two individuals married, their combined income of $390,000 would easily exceed the $250,000 threshold, triggering the high-income tax. This couple would owe an additional $1,260 in taxes. The marriage penalty on this couple would be even higher if some of their income was unearned because Obamacare taxes unearned income above the $250,000 threshold at a 3.8 percent rate.
Because the high-income tax is not indexed for inflation, more and more couples will pay this marriage penalty in the coming years. The Medicare actuary has estimated that, while this tax increase will affect only 3 percent of workers this year, it will affect 79 percent by 2080. As more and more middle-income Americans face this high-income tax over time, the Obamacare provisions will disproportionately affect married couples due to its structural penalty against marriage.
Means testing and joint filing has resulted in hundreds of billions of dollars in marriage penalties for low- and middle-income households. Essentially, when moderate-income couples marry, their marginal tax rate moves up from, say, 25 percent, to the 50 and 80 percent ranges shown above….
Not getting married is the major tax shelter for low- and moderate-income households with children. In many low-income communities around the nation, marriage is now the exception rather than the rule.
Marriage penalties or subsidies are assessed primarily for taking wedding vows, not for living together with another adult. Those who do not feel morally compelled to swear fidelity in religious or public ceremonies for the most part do not suffer the penalties. Our tax and welfare system thus favors those who consider marriage an option—to be avoided when there are penalties and engaged when there are bonuses. The losers tend to be those who consider marriage to be sacred.
Estimates vary widely, but scholars have said that changes in marriage patterns—as opposed to changes in individual earnings—may account for as much as 40 percent of the growth in certain measures of inequality. Long a nation of economic extremes, the United States is also becoming a society of family haves and family have-nots, with marriage and its rewards evermore confined to the fortunate classes. “It is the privileged Americans who are marrying, and marrying helps them stay privileged,” said Andrew Cherlin, a sociologist at Johns Hopkins University….
The President could not be more incorrect. By continuing failed policies that undermine the institution of marriage, Obamacare will accelerate a root cause of income inequality in the United States. Policymakers seeking to restore the institution of marriage and reduce income inequality in the process should work to eliminate the tax and welfare policies that penalize low-income and middle-income households who marry. A great place to start would be to repeal Obamacare because its marriage penalties will exacerbate income inequality.
Obamacare includes special provisions that allow many legal, non-citizen residents to qualify for federally subsidized insurance and, in so doing, offers these non-citizens more and better coverage options than American citizens. Section 1401, which creates Section 36B of the Internal Revenue Code, includes a “Special Rule for Certain Individuals Lawfully Present in the United States.” The rule states that lawfully present aliens with incomes under the federal poverty line who are “not eligible for the Medicaid program under Title XIX of the Social Security Act by reason of such alien status” shall be treated as if they had incomes above the federal poverty level, thus entitling them to federal insurance subsidies.
This special rule effectively circumvents the restrictions imposed by Congress in its landmark 1996 welfare reform legislation. In enacting welfare reform, Congress intended to prevent individuals from migrating into the United States and becoming public charges. Section 403 of the welfare reform bill included provisions prohibiting most legal aliens from receiving means-tested benefits, including most Medicaid benefits, for a five-year period. Obamacare did not explicitly override this five-year waiting period for legal aliens receiving taxpayer-funded benefits. Instead, Obamacare circumvented the prior law by creating a new entitlement—federal insurance subsidies in the new exchanges—with language ensuring legal aliens would qualify for this new program while in the five-year waiting period.
While legal residents who are not citizens will receive federal insurance subsidies under Obamacare, American citizens of modest means will qualify for Medicaid or may not receive health insurance at all. In states that expand their Medicaid programs, all citizens with incomes below 138 percent of the FPL who qualify for Medicaid will be automatically enrolled in the Medicaid program. In states that do not expand their Medicaid programs, citizens with incomes above 100 percent of the FPL will receive subsidies to purchase insurance coverage on the exchange, but citizens with incomes below 100 percent of the FPL may not qualify for subsidized insurance at all.
The law as implemented thus creates two inequities that place citizens at a disadvantage compared with legal aliens. First, in states that expand their Medicaid programs, citizens with incomes under 138 percent FPL will be automatically enrolled into Medicaid, while legal aliens will receive subsidies to purchase coverage in the exchange. In addition to denying citizens the option of the exchange granted to similarly situated legal aliens, this inequity also consigns an entire class of American citizens to a Medicaid program plagued by low physician reimbursement levels with a resulting history of poor health outcomes. Several studies show that patients with Medicaid coverage have worse outcomes than the uninsured, and some Medicaid beneficiaries do not consider the program “real insurance.” Yet Obamacare dumps millions of American citizens into this troubled program, even as it grants many legal aliens the opportunity to pick health plans of their choosing.
Second, in states that do not expand their Medicaid programs, legal aliens will be able to purchase subsidized health insurance on exchanges, while citizens below 100 percent of the poverty line may not qualify for subsidized coverage at all. The Supreme Court’s ruling on Obamacare found that the law’s Medicaid expansion, which required states to expand Medicaid or lose all their existing Medicaid funds, consisted of unconstitutional “economic dragooning” and made the expansion optional. The law as written did not envision such a scenario, assuming that all individuals below 100 percent of the FPL would be placed in the Medicaid program. The one exception was the “special rule” for legal aliens, thus allowing legal aliens, but no other individuals, below 100 percent of the FPL to receive insurance subsidies.
The solution to this problem is not for states to accept Obamacare’s massive Medicaid expansion. Expanding Medicaid would impose additional costs in the short term and even larger costs in the long term. Moreover, expanding Medicaid would consign millions of Americans to a flawed health program. Instead, the solution lies in repealing the special rule that offers non-citizens more and better coverage options than American citizens, potentially encouraging immigration to the United States by those seeking recourse to taxpayer-funded welfare programs.
Obamacare encourages states to expand their Medicaid programs to all individuals with incomes below 138 percent FPL by offering an enhanced Federal Medical Assistance Percentage (FMAP) covering the new expansion populations. The law provides for a 100 percent federal match for 2014 through 2016, phasing down over time to a 90 percent match by 2020.
The Medicaid expansion will not be cost free to states. Implementing the expansion will cost an estimated $12 billion in administrative costs, and state costs will rise as the federal matching percentage falls after 2016. However, the enhanced Medicaid match under Obamacare is significantly higher than the traditional FMAP rates covering the rest of the Medicaid program. Under existing law, FMAP rates for state Medicaid programs covering the aged, blind, and disabled populations can range from 50 percent to 83 percent. For fiscal year 2014, FMAP rates will range from 50 percent in 15 states to 73 percent in Mississippi.
Studies suggest that the vast majority of individuals to be covered under the enhanced Medicaid match are able-bodied adults. According to the Urban Institute, if all states expand Medicaid, over four in five uninsured adults eligible for coverage (82.4 percent) would be those without dependent children. Because many states already provide Medicaid coverage for parents with children, the number of additional parents eligible for coverage under the Obamacare expansion would be comparatively small. Moreover, of those adults eligible for Medicaid if all states expand Medicare, more than half (52.1 percent) would be ages 19–34, and more than five in six (86.6 percent) would be ages 19–54, which are the prime working years for most Americans.
Because most of the individuals gaining eligibility for Medicaid under the Obamacare expansion would be able-bodied adults of prime working age, these individuals should be able to work and therefore would likely earn enough income not to qualify for Medicaid coverage. An able-bodied adult, working full time (40 hours per week for 50 weeks per year) at a job paying $8 per hour would earn $16,000 annually, placing that individual above the 138 percent FPL cutoff for Medicaid eligibility. This hypothetical example strongly suggests that the able-bodied adults gaining Medicaid coverage under Obamacare are either unemployed or underemployed. It also suggests that Obamacare will exacerbate the existing poverty trap by providing benefits to adults able to work, but not currently employed.
Even as the federal government provides an enhanced federal match for state Medicaid programs to cover able-bodied adults, many more vulnerable individuals cannot obtain coverage from Medicaid. According to the Kaiser Family Foundation, 511,174 individuals are currently on waiting lists in 37 states for access to home and community-based services under Medicaid waiver programs. Of these individuals, more than 316,000 seek Medicaid services due to intellectual or developmental disabilities. Yet in creating an enhanced federal match for states to participate in Obamacare’s Medicaid expansion, Congress created a very clear signal that covering able-bodied adults constitutes a greater priority than covering the aged, blind, and disabled populations that Medicaid currently covers.
A public safety net is necessary for those truly in need. However, by spending more than $700 billion on its massive Medicaid expansion, Obamacare places a greater emphasis on covering able-bodied adults than the disabled populations that Medicaid was originally intended to serve. By extending health coverage to those who should be able to work, Obamacare could jeopardize the coverage of disabled populations. Moreover, by subsidizing health coverage for millions of unemployed and underemployed, Obamacare could accelerate the development of a permanent underclass who chooses not to work because there is little financial incentive to work.
Repeal all of Obamacare. The penalties and disincentives that the law places on Americans are compelling reasons for Congress to repeal this harmful and misguided legislation.
Expand work requirements for able-bodied adults. Even after the repeal of Obamacare’s new entitlements, policymakers should examine and bolster work requirements for other welfare benefits to preserve incentives for the able-bodied to work or prepare for work.
Reaffirm the importance of marriage. While Congress reduced the marriage penalties in the tax code in the past decade, policymakers should examine and revise policies in the tax code and elsewhere to promote committed marital relationships.
Maintain waiting periods before legal residents can access welfare benefits. Obamacare undermines one basic premise of the 1996 welfare reform: A legal immigrant should not become a public charge immediately upon arrival in the United States. Particularly given record federal deficits, Congress should restore this principle as a way to curb soaring entitlement spending.
Restore Medicaid’s focus on the neediest citizens. Given its poor outcomes for patients, Medicaid needs significant changes. However, true reform cannot come from adding able-bodied adults to an already overburdened program. Instead, Congress should focus on improving Medicaid’s quality of care, while restoring its emphasis on providing a safety net for the truly needy.
The subsidy formulae and minutiae underpinning Obamacare represent a complex set of choices enacted by Congress more than three years ago. Each of these policy choices is antithetical to traditional American values: the spirit of entrepreneurship and work, the marital bonds that have served as the touchstone of strong families for generations, the spirit of self-reliance that led immigrants to come to these shores to contribute to American society, and a safety net focused on protecting those in greatest need.
Collectively, these policy choices send a clear signal that reliance on government supersedes these traditional American values. While liberals argue that Obamacare is a compassionate law, the facts suggest the exact opposite. The law is not compassionate because it further entrenches a superstructure that penalizes work and encourages dependence for a wide swathe of Americans.
In calling for Obamacare’s repeal, opponents have pointed out the law’s economic impacts, its new bureaucracy, and its negative impacts on the American health care system. But conservatives should also make a values-based case against Obamacare. The American people deserve better than a law rooted in the notion that some individuals cannot improve their station in life and therefore should not be encouraged to work or advance their condition.
 Barack Obama, “Congress Must Act Now to Pass a Budget and Raise the Debt Ceiling,” The White House, September 21, 2013, http://www.whitehouse.gov/the-press-office/2013/09/21/weekly-address-congress-must-act-now-pass-budget-and-raise-debt-ceiling (accessed October 21, 2013).
 The Heritage Foundation, “The Case Against Obamacare: Health Care Policy Series for the 112th Congress,” http://www.heritage.org/research/projects/the-case-against-obamacare.
 Congressional Budget Office, “Effects on Health Insurance and the Federal Budget for the Insurance Coverage Provisions in the Affordable Care Act—May 2013 Baseline,” May 14, 2013, p. 2, Table 2, https://www.cbo.gov/publication/44190 (accessed October 21, 2013).
 Fox News, “Obama—Spread the Wealth Around,” video file, PopModal, http://www.youtube.com/watch?v=OoqI5PSRcXM (accessed October 21, 2013).
 Patient Protection and Affordable Care Act (PPACA), Public Law 111–148, § 1401, as amended by the Health Care and Education Reconciliation Act (HCERA), Public Law 111–152, http://housedocs.house.gov/energycommerce/ppacacon.pdf (accessed October 21, 2013).
 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, “2013 Poverty Guidelines,” January 24, 2013, http://aspe.hhs.gov/poverty/13poverty.cfm (accessed October 21, 2013).
 Henry J. Kaiser Family Foundation, “Subsidy Calculator,” http://kff.org/interactive/subsidy-calculator/ (accessed October 22, 2013). All figures are in 2014 dollars.
 Casey Mulligan, “How Obamacare Wrecks the Work Ethic,” The Wall Street Journal, October 3, 2013, http://online.wsj.com/news/articles/SB10001424127887323623304579061423122639430 (accessed October 27, 2013).
 Gene Steuerle, “Marginal Tax Rates, Work, and the Nation’s Real Tax System,” testimony before the Subcommittee on Human Resources and Subcommittee on Select Revenue Measures, Committee on Ways and Means, U.S. House of Representatives, June 27, 2012, http://waysandmeans.house.gov/UploadedFiles/Eugene_Steuerle_Testimony_HR-SRM_062712.pdf (accessed October 21, 2013).
 Of the non-elderly population of 267.4 million, 170.5 million live in households with incomes under 400 percent of poverty. U.S. Census Bureau, “Annual Social and Economic Supplement: 2012 Poverty Table of Contents,” September 2013, Table POV01, http://www.census.gov/hhes/www/cpstables/032013/pov/pov01_400_1.xls (accessed October 21, 2013).
 Congressional Budget Office, “The Budget and Economic Outlook: An Update,” August 2010, p. 48, Box 2-1, and p. 66, http://cbo.gov/sites/default/files/cbofiles/ftpdocs/117xx/doc11705/08-18-update.pdf (accessed October 21, 2013).
 J. Lester Feder and Kate Nocera, “CBO: Health Law to Shrink Workforce by 800,000,” Politico, February 10, 2011, http://www.politico.com/news/stories/0211/49273.html (accessed October 21, 2013).
 James Sherk, “Not Looking for Work: Why Labor Force Participation Has Fallen During the Recession,” Heritage Foundation Backgrounder No. 2722, September 5, 2013, http://www.heritage.org/research/reports/2013/09/not-looking-for-work-why-labor-force-participation-has-fallen-during-the-recession.
 Drew Gonshoworski, “The Affordable Care Act Negatively Impacts the Supply of Labor,” Heritage Foundation Issue Brief No. 3873, March 11, 2013, http://www.heritage.org/research/reports/2013/03/impact-of-the-patient-protection-and-affordable-care-act-on-labor-supply.
 For similar analyses from an earlier version of Obamacare, see Robert Rector, “The New Federal Wedding Tax: How Obamacare Would Dramatically Penalize Marriage,” Heritage Foundation WebMemo No. 2767, January 20, 2010, http://www.heritage.org/research/reports/2010/01/the-new-federal-wedding-tax-how-obamacare-would-dramatically-penalize-marriage.
 Henry J. Kaiser Family Foundation, “Subsidy Calculator.” All figures are in 2014 dollars.
 Section 9015 of the PPACA established the 0.9 percent tax on wage income, and Section 1402 of HCERA established the 3.8 percent tax on unearned income.
 ($390,000 – $250,000) * 0.9 percent = $1,260.
 Centers for Medicare and Medicaid Services, 2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds, August 5, 2010, p. 87, http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2010.pdf (accessed October 21, 2013).
 Chuck Donovan, “A Marshall Plan for Marriage: Rebuilding Our Shattered Homes,” Heritage Foundation Backgrounder No. 2567, June 7, 2011, http://www.heritage.org/research/reports/2011/06/a-marshall-plan-for-marriage-rebuilding-our-shattered-homes (accessed October 21, 2013).
 Jason DeParle, “Two Classes in America, Divided by ‘I Do,’” The New York Times, July 15, 2012, http://www.nytimes.com/2012/07/15/us/two-classes-in-america-divided-by-i-do.html (accessed October 21, 2013).
 ABC News, “Transcript: President Barack Obama,” This Week, September 15, 2013, http://abcnews.go.com/ThisWeek/week-transcript-president-barack-obama/story?id=20253577 (accessed October 21, 2013).
 For more on the link between marriage and poverty, see Robert Rector, “Marriage: America’s Greatest Weapon Against Child Poverty,” Heritage Foundation Special Report No. 117, September 5, 2012, http://www.heritage.org/research/reports/2012/09/marriage-americas-greatest-weapon-against-child-poverty.
 26 U.S. Code § 36B(c)(1)(B). This specific provision was created by PPACA, § 1401.
 Personal Responsibility and Work Opportunity Act, Public Law 104–193, § 403.
 Section 2001(a)(1)(C) of PPACA established the Medicaid eligibility threshold at 133 percent of poverty; however, Section 1004(e)(2) of HCERA amended this requirement by adding an automatic 5 percent income disregard, effectively establishing an eligibility threshold of 138 percent of poverty.
 26 U.S. Code § 36B (c)(1)(A), as amended by PPACA, § 1401.
 Robert E. Moffit and Edmund F. Haislmaier, “Obamacare’s Insurance Exchanges: ‘Private Coverage’ in Name Only,” Heritage Foundation Backgrounder No. 2846, September 26, 2013, http://www.heritage.org/research/reports/2013/09/obamacares-insurance-exchanges-private-coverage-in-name-only.
 Many of these studies are summarized in Scott Gottlieb, “Medicaid Is Worse Than No Coverage at All,” The Wall Street Journal, March 10, 2011, http://online.wsj.com/article/SB10001424052748704758904576188280858303612.html (accessed October 21, 2013).
 Vanessa Fuhrmans, “Note to Medicaid Patients: The Doctor Won’t See You,” The Wall Street Journal, July 19, 2007, http://online.wsj.com/article/SB118480165648770935.html (accessed October 21, 2013).
 NFIB v. Sebelius, 567 U.S. 52 (2012), http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf (accessed October 21, 2013).
 Edmund F. Haislmaier and Brian Blase, “Obamacare: Impact on States,” Heritage Foundation Backgrounder No. 2433, July 1, 2010, http://www.heritage.org/research/reports/2010/07/obamacare-impact-on-states.
 Drew Gonshorowski, “Obamacare and the Medicaid Expansion: How Does Your State Fare?” March 5, 2013, http://blog.heritage.org/2013/03/05/obamacare-medicaid-expansion-state-by-state-charts/ (accessed October 21, 2013).
 PPACA, § 2001(a)(3), as amended by HCERA, § 1201(1)(B).
 42 U.S. Code § 1396d(b).
 Federal Register, November 30, 2012, p. 71422, Table 1, http://www.gpo.gov/fdsys/pkg/FR-2012-11-30/pdf/2012-29035.pdf (accessed October 21, 2013).
 Genevieve M. Kenney et al., “Opting in to the Medicaid Expansion Under the ACA: Who Are the Uninsured Adults Who Could Gain Health Insurance Coverage?” Urban Institute, August 2012, p. 9, Appendix Table 2, http://www.urban.org/UploadedPDF/412630-opting-in-medicaid.pdf (accessed October 21, 2013).
 Henry J. Kaiser Family Foundation, “Adult Income Eligibility Limits at Application as a Percent of the Federal Poverty Level (FPL),” January 2013, http://kff.org/medicaid/state-indicator/income-eligibility-low-income-adults/ (accessed October 21, 2013).
 Kenney et al., “Opting in to the Medicaid Expansion Under the ACA,” Appendix Table 1, p. 8.
 Edmund F. Haislmaier, “New Medicaid Welfare Trap,” The Heritage Foundation, May 29, 2013, http://www.heritage.org/research/commentary/2013/5/new-medicaid-welfare-trap. First published in The Philadelphia Inquirer.
 Henry J. Kaiser Family Foundation, “Waiting Lists for Medicaid Section 1915(c) Home and Community-Based Services (HCBS) Waivers,” December 2012, http://kff.org/medicaid/state-indicator/waiting-lists-for-hcbs-waivers-2010/#table (accessed October 21, 2013).
 Congressional Budget Office, “Effects on Health Insurance and the Federal Budget,” Table 2.
 For instance, see Robert Rector and Jennifer A. Marshall, “The Unfinished Work of Welfare Reform,” January 22, 2013, http://www.heritage.org/research/reports/2013/01/the-unfinished-work-of-welfare-reform (accessed October 21, 2013).
 Kevin Dayaratna, “Studies Show: Medicaid Patients Have Worse Access and Outcomes Than the Privately Insured,” Heritage Foundation Backgrounder No. 2740, November 7, 2012, http://www.heritage.org/research/reports/2012/11/studies-show-medicaid-patients-have-worse-access-and-outcomes-than-the-privately-insured.
 Nina Owcharenko, “Saving the American Dream: A Blueprint for Putting Patients First,” Heritage Foundation Issue Brief No. 3628, June 6, 2012, http://www.heritage.org/research/reports/2012/06/saving-the-american-dream-a-blueprint-for-putting-patients-first.
Millions of Americans are finding out they will lose their current health plan due to Obamacare. Contrary to the statements made by some, Obamacare interrupts insurance for everyone, not just the Americans who purchase coverage directly in the individual market.
These sweeping changes are why the President’s proposed actions, and alternative legislative efforts like Chairman Fred Upton’s “Keep Your Health Plan Act” (H.R. 3350), Senator Ron Johnson’s S. 1617, and Senator Mary Landrieu’s S. 1642, while well intentioned, will not solve the problem. The Upton bill, for example, would allow people to enroll in plans that currently exist in the individual market for one more year. All of these efforts are temporary and, most importantly, do not roll back the many onerous Obamacare mandates that disrupt coverage for the 49 percent of Americans with employer-provided coverage.
• While the Obamacare bill included “grandfathered” plan language theoretically allowing Americans to keep plans they have and like, other sections of the legislation undermined this promise. For instance, Section 2301 of the reconciliation legislation included provisions requiring all plans, including “grandfathered” plans, to abide by some of the law’s new benefit mandates—thus making the plans different from pre-Obamacare offerings.
• Shortly after the law’s enactment, the Obama Administration released regulations further restricting individuals’ ability to keep their pre-Obamacare plans. The regulations stated that an increase in co-payments of more than $5, or an increase in the employee’s share of premiums paid by more than 5 percent, could cause plans to lose “grandfathered” status.
• The result: the percent of covered workers in “Grandfathered plans” went from 56 percent in 2011 to 36 percent in 2013. Employer-provided coverage is impacted by Obamacare in this and many other ways.
• Because individuals who buy their own health insurance receive no employer subsidy for their health coverage, and often receive no taxpayer subsidy, they frequently shop for the most economical plan available. However, most individual plans do not comply with Obamacare’s new mandated benefits.
• Obamacare includes a list of 10 “essential benefits” that health plans must cover—including coverage of maternity services, habilitative services, and pediatric vision care.
• The law also requires that most health plans cover at least 60 percent of expected medical expenses. A study last year suggested that more than half of individual market insurance policies do not meet these so-called actuarial value requirements.
• Because they do not comply with the law’s new required benefits, one expert has concluded that as many as 85 percent of individual health insurance policies—affecting up to 16 million individuals—will be canceled due to Obamacare.
• Obamacare’s effects will not be felt only in the individual market. The Administration’s own regulations assumed that up to 69 percent of small business plans—covering as many as 41 million Americans—could be lost, because they do not comply with Obamacare’s requirements.
• For instance, Obamacare sets maximum deductibles for small business insurance plans at $2,000 for a single person. However, nearly one-third of covered workers at small firms are in plans that do not meet this requirement—meaning these individuals could face higher costs, or the loss of their current plan, or both.
• When it comes to both individual and small business insurance policies, losing one’s policy will often come with a big price tag. A Heritage Foundation analysis concluded that Obamacare’s benefit mandates will raise individual insurance premiums in 42 out of 47 states, in many cases causing rates to double.
Just as eliminating pre-Obamacare health plans was one major result of the law, so too are the higher premiums many will face upon losing their plan. It’s why the American people need relief from this unworkable, unfair, and unpopular law.
This post was originally published by The Heritage Foundation.
Is the Administration Offering Insurers an Obamacare Bailout?
The Centers for Medicare and Medicaid Services (CMS) today released guidance to state insurance commissioners implementing President Obama’s “fix” for people losing their insurance. Not only does it violate the explicit text of Obamacare itself, but it also raises the possibility of insurers getting access to a new pool of bailout funds.
Though this transitional policy was not anticipated by health insurance issuers when setting rates for 2014, the risk corridor program should help ameliorate unanticipated changes in premium revenue. We intend to explore ways to modify the risk corridor program final rules to provide additional assistance.
To translate into English: If some Americans can keep their pre-Obamacare health plans next year, they will not enroll in the Obamacare exchanges. That means the enrollees in the exchanges are likely to be sicker than insurers previously expected. Already this afternoon, the health insurance industry trade association has alleged the President’s “fix” could have a significant impact on premiums in the marketplace, for that very reason.
The CMS guidance today raises the possibility of using Obamacare’s risk corridor program to compensate insurers for these losses. Briefly stated, the risk corridor program shifts funds among insurers—it minimizes losses from carriers with sicker-than-expected enrollees, by redistributing gains from carriers with healthier-than-expected enrollees.
But as has been noted elsewhere, the risk corridor program “doesn’t need to be budget neutral; if the math demands it, the government can pay out more than it collects through the program.” CMS’s comments today imply that it’s contemplating exactly that—undoing the concept of budget neutrality for the risk corridor program, and using it to compensate insurers for their losses.
According to the Congressional Budget Office, Obamacare already gives more than $1 trillion in subsidies to insurance companies over the next 10 years. President Obama’s extra-legal “fix” could now result in the Administration offering insurers a bailout totaling billions of dollars more. It’s one more reason why there is only one real Obamacare “fix,” and that’s scrapping the law entirely.
President Obama has told Obamacare’s critics that the law is “settled” and “here to stay.” But today he is saying he’ll violate the law to put a Band-Aid on it for another year. That’s in addition to the one-year delay in the employer mandate and numerous other “fixes” and delays.
The President is announcing his “fix” to the problem of millions of canceled policies: According to press reports, the President’s “plan would allow people to keep their plans into 2014,” by allowing the sale of insurance plans that don’t meet the law’s new requirements.
There’s one problem—the President’s promise that his new “plan” can allow people to keep their plans is just as flawed and false as his original “like your plan/keep it” pledge. The law itself is clear: Obamacare’s new benefit mandates—the requirement to cover all individuals with pre-existing conditions, the new “essential benefits,” and mandates increasing the percentage of health costs insurance plans must cover—all take effect on January 1, 2014.
As any follower of Schoolhouse Rock will know, there’s only one institution that can change the law: Congress. President Obama’s “plan” attempts to ignore them entirely. The President’s proposal is but the latest in a long line of waivers and unilateral changes made in a futile attempt to repair an inherently unworkable law.
The ultimate “fix” lies with Congress, and it’s a simple one: Undo this unfair, unworkable, and unpopular law that never should have been passed in the first place.
The first Obamacare enrollment numbers are out—and unsurprisingly, they’re under-whelming. Just 26,794 people “selected” plans through HealthCare.gov since the website launched. An additional 79,391 have selected plans through a state-based exchange—but the Administration qualifies these numbers by saying that all of these people haven’t necessarily paid for a plan yet. The act of putting it in a shopping cart got them on the list.
In a speech three weeks ago, President Obama compared buying health insurance online through the exchanges to “the day after Thanksgiving sales for the latest PlayStation or flat-screen TV.” But comparing today’s anemic numbers to a true giant of the retail trade only shows the depth of the federal government’s Obamacare ineptitude.
According to The Fiscal Times, McDonald’s sells an average of 75 hamburgers every second. That’s 4,500 hamburgers per minute, or 270,000 per hour. In other words, people selected fewer Obamacare policies in one month—that’s 44,640 minutes—than McDonald’s sells hamburgers in half an hour.
True, McDonald’s sells hamburgers all over the world, not just in the United States. But today’s Obamacare numbers are themselves inflated—because they include people who haven’t actually paid for an insurance plan. Today’s data include as “enrollees” those who have merely placed one insurance option in their online shopping cart—even though the Administration’s own chief technology officer admitted this morning that retailers like Amazon do not count items in customers’ shopping carts as “sales” until those items are actually paid for.
It’s outrageous that the federal government has proven so incapable of designing a website that functions properly. But the bigger tragedy is that millions of people are losing their insurance coverage—as many as 16 million losing their individual health insurance plans, according to one estimate. The exchanges’ failure leaves these struggling Americans with fewer options to buy replacement coverage—and the options they will find on the exchanges, if and when they can access them, will in many cases be vastly more expensive.
It’s becoming clearer every day that this law is fundamentally unworkable. Not only should HealthCare.gov go; so should all of Obamacare.
In response to the wave of insurance cancellations hitting millions of Americans, and the admission by some that President Obama’s “if you like your plan” promise was false, Obamacare’s defenders are now taking a different tack.
While the law’s supporters finally admit that some people will be worse off under the law, they now claim that those “losers” will be few and far between.
• If you have insurance through an employer: The administration claims that employer-provided coverage is not changing under Obamacare – even as it brags that Obamacare is providing better benefits to those with employer plans.
Those “better benefits” are not free, however. One recent survey from the New York-based Mercer consulting firm found that half of large employers believe Obamacare will raise health costs by at least 2 percent next year.
With the average employer plan costing more than $16,000 per family, even a 2 percent increase amounts to hundreds of dollars in added costs for employers and families every year – for “benefits” they may not have wanted to purchase absent a government order.
• If you buy insurance yourself: As many Americans have found in recent weeks, the odds are that those who previously purchased their own health plan will not be able to keep it. Some experts have predicted that as many as 16 million individuals could fall into this category.
Individuals whose insurance has been canceled will have to buy Obamacare-compliant insurance. As a result, they may face substantially higher premiums for insurance coverage that provides a smaller network of doctors and hospitals.
• If you qualify for subsidized insurance: Defenders of the law would argue that these individuals are clear “winners” under Obamacare. But many of these Americans may use taxpayer subsidies to buy insurance coverage they don’t need or want – because the federal government has forced them to, and/or because Washington bureaucrats have taken away their existing plan.
What’s more, the nearly $1.8 trillion in spending on exchange plans and for Medicaid will create a significant new burden for future generations of taxpayers.
• If you are a senior citizen on Medicare: Obamacare will affect seniors as well – because, as House Minority Leader Nancy Pelosi, D-Calif., famously said in 2011, Democrats “took half a trillion dollars out of Medicare in (Obamacare)” to fund the law’s new entitlements.
The administration’s nonpartisan actuary concluded that the law’s unsustainable spending reductions to Medicare could cause 15 percent of hospitals to become unprofitable by 2019, and 40 percent to become unprofitable by 2050 – which could have a significant impact on beneficiaries’ access to care.
The idea that “only” 3 percent of Americans will end up on the short end of a 2,700-page law remaking the nation’s health care system seems as fanciful as the president’s pledge that those who like their current plan could keep it.
The facts are clear: Obamacare isn’t just unfair for a small percentage of Americans; it’s unfair for the entire country.
This post originally appeared in the Wichita Eagle.
In response to the wave of insurance cancellations hitting millions of Americans, and the admission by some on the left that President Obama’s “if you like your plan” promise was false, Obamacare’s defenders are now taking a different tack.
If You Have Insurance Through an Employer: The Administration claims that employer-provided coverage is not changing under Obamacare—even as it brags that Obamacare is providing better benefits to those with employer plans. Those “better benefits” are not free, however. One recent survey from consultants at Mercer found that half of large employers believe Obamacare will raise health costs by at least 2 percent next year. With the average employer plan costing more than $16,000 per family, even a 2 percent increase amounts to hundreds of dollars in added costs for employers and families every year—for “benefits” they may not have wanted to purchase absent a government order.
If You Buy Insurance Yourself: As many Americans have found in recent weeks, the odds are that those who previously purchased their own health plan will not be able to keep it. Some experts have predicted that as many as 16 million individuals could fall into this category. Individuals whose insurance has been canceled will have to buy Obamacare-compliant insurance. As a result, they may face substantially higher premiums for insurance coverage that provides a smaller network of doctors and hospitals.
If You Qualify for Subsidized Insurance: Defenders of the law would argue that these individuals are clear “winners” under Obamacare. But many of these Americans may use taxpayer subsidies to buy insurance coverage they don’t need or want—because the federal government has forced them to, and/or because Washington bureaucrats have taken away their existing plan. What’s more, the nearly $1.8 trillion in spending on exchange plans and for Medicaid will create a significant new burden for future generations of taxpayers.
If You Are a Senior Citizen on Medicare: Obamacare will affect seniors as well—because, as House Minority Leader Nancy Pelosi (D-CA) famously said in 2011, Democrats “took half a trillion dollars out of Medicare in [Obamacare]” to fund the law’s new entitlements. The Administration’s non-partisan actuary concluded that the law’s unsustainable spending reductions to Medicare could cause 15 percent of hospitals to become unprofitable by 2019, and 40 percent to become unprofitable by 2050—which could have a significant impact on beneficiaries’ access to care.
The idea that “only” 3 percent of Americans will end up on the short end of a 2,700-page law remaking the nation’s health care system seems as fanciful as the President’s pledge that anyone who likes their current plan could keep it.
The American people deserve better.
Over the weekend, Heritage brought you the exclusive story of Justin Hadley, a North Carolina man who, after learning his insurance policy was being canceled due to Obamacare, logged on to HealthCare.gov and found a big surprise—the eligibility information of another family in a different state.
It’s just the latest example of problems with the federally run insurance exchange—from design features that locked Americans out of the website, to inaccurate information about premiums, to a lack of transparency about what caused the online failures in the first place.
Violates Obama’s Promises: Across the country, millions of Americans are finding out the same news as Justin: that the insurance they have and like is being taken away from them due to Obamacare. In fact, the cancellation notices being sent due to Obamacare may well exceed the number of Americans gaining coverage as a result of the law.
Violates Families’ Pocketbooks: Justin was told that a new insurance plan with his same insurer would cost him 92 percent more in premiums. That’s because the mandates and requirements included in Obamacare are raising premiums for many Americans. A recent Heritage study found that, for those buying coverage in the private market, premiums will rise in 45 out of 50 states, in many cases doubling.
Violates Principles of Freedom: For the first time ever, Obamacare forces Americans to buy a product. And Americans don’t just have to buy health insurance—they have to buy government-approved health insurance. That’s why many Americans are losing the current coverage they have and like—because it doesn’t meet the diktats of Washington bureaucrats.
Violates Americans’ Consciences: Obamacare forces many employers to offer, and individuals to purchase, coverage that violates the core tenets of their faith regarding the protection of life. These requirements are currently being challenged in court cases across the country, as Americans protest the concept that they should have to choose between violating the law and violating their deeply held religious beliefs.
Obamacare is a deeply flawed law, and its flaws have become more apparent with each passing day. It’s not just that people’s personal data has become insecure due to government bungling—their financial security and the security of their deeply held beliefs are likewise at stake.
The American people need relief from this inherently unworkable law.

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