Sunday, February 23, 2014

February, 2014 The Unfolding Disaster That Is Obama Care, Part 4: Closing Hospitals and Shredding the Constitution While Trying To Fix the Law

This is the fourth post this month that examines the unfolding disasters that are constantly coming out of Obama Care. For three years we have been correctly predicting that this will be a disastrous piece of legislation that will damage the economy without its intended purpose of reining in ever escalating health care costs.

Since August, 2013 we have usually had to dedicate upwards of six or seven posts a month to stay on top of the fiascos. Those in depth previous posts can be accessed by looking at the lists of posts each month to the right of this screen. The first post in this month’s series can be accessed at:

Let’s get started with Day 4’s disasters below:

1) Obama Care was supposed to reduce health care costs, the President promised that the average American’s annual health insurance bill would decrease by $2,500. But the law was written so poorly that many doctors are retiring early because of the hassles within the law which will reduce supply and increase health care costs, not decrease costs.

Early results of looking at Obama Care health exchange policies show that the vast majority of policies are MORE expensive than previous policies that Americans could own but no longer can get access to. This too will increase health care costs. 

Many medicines that were covered by previous polcies are not covered by Obama Care policies, further increasing costs for Americans. Thus, there are many factors and unintended consequences of the law that are doing the exact opposite of what it is supposed to do, i.e. reduce costs.

To that list of cost increasers it looks like we now have to add the fact that many hospitals across the country, especially those serving poorer and more rural populations of Americans, are being forced to close because Obama Care is causing the Federal government to decrease the reimbursement levels that had previously, pre-Obama Care, had been in effect.

As an example, the fourth Georgia hospital in two years is closing its doors due to severe financial difficulties caused by the law’s payment cuts for emergency services. The Lower Oconee Community Hospital is a small rural hospital that is suffering from serious cash-flow problems, largely due to the area’s uninsured population. Federal law requires all hospitals to treat all people that come to their emergency rooms for treatment and later be reimbursed by the Federal government for the service.

This hospital serves a poorer population where about 23% of the population does not have health care insurance. Thus, the uninsured usage of the hospital is high and as the Federal government cuts the levels of reimbursement, these four hospitals and others across the country have to shut down, leaving these poorer, less fortunate Americans with less health care coverage, all because of Obama Care.

Apparently, the problem is the result of the Supreme Court decisions that validated most of Obama Care but allowed states to opt out of its Medicaid expansion. The law was written assuming that all states would be involved in the Medicaid expansion. When half of them opted out, it destroyed the financial integrity of the law’s business case and the reimbursement levels to these less affluent hospitals.

Thus, we will now see a lower supply (i.e. fewer hospitals) which will grow the costs of health care even more since there is less supply and competition, the exact opposite of what Obama Care was supposed to do.

2) It seems like every week or so for the past year, Obama has decided to change something in the health care law for a variety of different reasons. He, of course, had no right or legal standing to do so since the law was legally approved by Congress and turned over to the executive branch to execute and put into operation. Under our Constitution, the President has no authority not to implement the law as it was written, debated, voted, on and enacted. 

If any changes needed to be made, assuming the President actually accepted and believed in the Constitution, he would have gone back to Congress and worked with them to amend the law to account for unforeseen obstacles. That it was a democracy is all about, everyone gets to have their opinion heard and voted on. Apparently, that is merely a suggestion for the administration, not a centuries old tradition and legal precedent.

How many illegal unilateral changes has the President made? A recent Fox Business analysis on February 12, 2014 identified 28 major changes and counting:
  1. November 6, 2012 Medicaid physician reimbursements: Increased reimbursements for primary-care physicians who treat Medicaid beneficiaries didn’t go into effect on Jan. 1, 2013, as scheduled. 
  2. January 31, 2013 Bundled Payments initiative: The Obama administration was late starting an experiment with changes to how doctors and hospitals are paid by Medicare, which was slated to take effect Jan. 1, 2013.
  3. February 1, 2013 Medicaid funds and preventive care: Increased federal funding for states that eliminate Medicaid co-payments for preventive care didn’t really go into effect on Jan. 1, 2013, as scheduled. 
  4. February 6, 2013 Basic Health Program: The federal government announced a one-year delay for the “Basic Health Program.” 
  5. February 20, 2013 Out-of-pocket costs: The administration announced that the law’s cap on out-of-pocket costs of $6,350 for individuals and $12,500 for families will not be enforced for some employer-based health insurance plans until 2015
  6. April 1, 2013 Small Business Health Options Program: The federal government announced that the Small Business Health Options Program (SHOP) will be delayed until 2015. 
  7. July 2, 2013 Employer mandate: The Obama administration announced that the employer mandate requiring employers with at least 50 full-time workers to provide them with coverage or pay a penalty will now be enforced starting in 2015, not 2014 as originally planned. 
  8. July 2, 2013 Employer reporting requirements: The Obama administration announced that it is going to also delay, until 2015, associated reporting requirements relating to potential employer penalties. 
  9. July 5, 2013 Verifying coverage status: The Obama administration announced that it has decided to roll back requirements for new state insurance marketplaces to verify health coverage status of people who apply for subsidized coverage. 
  10. July 5, 2013 Verifying income: The Obama administration announced that it had decided to roll back requirements for new state insurance marketplaces to verify the income of people who apply for subsidized coverage. 
  11. July 5, 2013 Electronic Medicaid notices: The Obama administration announced a delay in the requirement that state Medicaid agencies be able to use electronic notices to notify individuals of their eligibility for federal assistance. 
  12. August 27, 2013 Finalizing federal exchange plans: CMS notified insurance companies that it would delay signing final agreements on plans for the new insurance exchanges. 
  13. September 26, 2013 Online enrollment for small-business exchanges: HHS said employers with 50 or fewer workers will not be able to sign their staff up for insurance in federally operated exchanges until a month later, November 1, because of technical problems. 
  14. September 26, 2013 Online enrollment in Spanish: The Obama administration announced that the Spanish-language version of will not be equipped to handle online enrollments on Oct 1. 
  15. October 23, 2013 March enrollment deadline: The Obama administration said that it would delay imposing penalties for six weeks on some consumers who might have been caught in a sticky timing problem for enrolling in coverage through the health law’s new insurance exchanges. 
  16. November 14, 2013 Canceled insurance plans and minimum standards: The Obama administration announced that it is allowing insurers to extend existing individual and small group plans for one more year for current customers even if those insurance policies don’t meet the minimum standards set by the health reform law. 
  17. November 22, 2013 Extra days to enroll for Jan. 1, 2013 coverage: Americans hoping to sign up for health insurance under health reform will have an additional eight days to do so for coverage to begin January 1, 2014. 
  18. November 22, 2013 Health Insurance Enrollment for 2015: The administration pushed back the period during which Americans sign up for coverage under health reform in its second year of operation, a change that could reassure insurers while also avoiding the 2014 midterm elections. 
  19. November 27, 2013 Online enrollment for small businesses: The Small Business Health Options Program, known as the SHOP exchange, will not offer online enrollment until November 2014, a one-year. 
  20. December 12, 2013 Payment deadline delayed: HHS Secretary Kathleen Sebelius for the first time directed insurers to give consumers until Dec. 31 to pay their first-month premiums. 
  21. December 12, 2013 High-risk insurance pools: About 85,000 people with a history of serious illnesses, who are enrolled in high-risk insurance pools created under the health reform law, will get a month’s reprieve before they lose that coverage. 
  22. December 19, 2013 Delay of individual mandate for some: The Obama administration will not require the millions of Americans who received health-insurance plan cancellation notices to purchase a new policy next year. 
  23. December 23, 2013 Extra day to enroll for Jan. 1, 2013 coverage: The Obama administration extended a deadline for health insurance under health reform, giving consumers shopping on in 36 states an extra day, until Dec. 24, to pick plans to kick in for coverage beginning Jan. 1.
  24. January 14, 2014 High-risk insurance pools: About 30,000 people (down from 85,000 in October) with a history of serious illnesses, who are enrolled in high-risk insurance pools created under the health reform law, will get an additional two months -- until March 31 -- before they lose that coverage. 
  25. January 18, 2014 Equal coverage rules: The Obama administration is delaying enforcement of a provision of the health reform law that prohibits employers from providing better health benefits to top executives than to other employees. 
  26. February 10, 2014 Employer mandate for medium-sized employers: The Obama administration announced it would give medium-sized employers (businesses with between 50 and 99 employees) an extra year, until 2016, before they must offer health insurance to their full-time workers. 
  27. February 10, 2014 Employer mandate coverage percentage: The Obama administration announced that they would phase in the percentage of full-time workers that employers with more than 100 employees need to offer coverage to from 70 percent in 2015 to 95 percent in 2016 and beyond. 
  28. February 10, 2014 Measuring employees for employer mandate: The Obama administration announced that they are allowing companies that have close to 100 workers some discretion in whether they have to comply. 
A more detailed discussion and the entire article can be accessed at:

A few of observations, beyond the illegality, unconstitutional, and probably impeachable offenses of making these changes to established law without getting approval of Congress and the people they represent, American citizens:
  • First, how incompetent is this executive branch and administration if after three years, billions of dollars and probably tens of millions of man hours that they cannot put together an operation that now how has to be fixed by at least 28 major and different delays and changes? Answer: very incompetent.
  • Second, I think we see another reason why this is such an amazingly bad piece of legislation. If you have to make 28 major changes to a law that you and your political peers wrote themselves, remember that no Republicans voted to enact this law, how badly was it written or how ignorant are you of reality that so many changes have to be made? Answer: very ignorant.
  • Finally, how many of these decisions were made for the good of the country and the health of Americans and how many were done for political and political calendar reasons? I would venture a guess that the majority of these were done to minimize the negative impact on Democratic politicians rather than focusing on what is best for the country. That is what turns this President away form being a feraless leader and towards being nothing more than a typcial Chicago politician.
Okay, I thought we could get through all the disasters today but that was asking too much, especially when we start getting into obvious violations of the Constitution. Hopefully, tomorrow we can get through it all before more disasters unfold.

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