Before you dig into the truth about this legislation take a good look at your new health care system brought to by a 100% Partisan Democrat vote. Watch: “Obamacare: The biggest bureaucratic nightmare in world history.”
You can read the two pieces of legislation that comprise “Obamacare” by clicking here: “PPACA – Patient Protection & Affordable Care Act” and here: “Health Care & Education Reconciliation Act” Since funding for IPAB – the Independent Payment Advisory Board (more on that below) was provided in the “Stimulus” bill. It is important to also read the “American Recovery and Reinvestment Act” of 2009. Since the passage of “Obamacare”, there have been 13,000 pages of new regulations added. This being the case, date stamped updates are the best way to break it down.
November 25, 2012 UPDATE The next time someone tells you that the reason health insurance premiums are so expensive is because of ‘insurance company CEO salaries’ and ‘cost shifting’ from uninsured Emergency Room bills. Your response should be that the REAL ‘cost shifting’ is the $90 BILLION a YEAR from Medicare and Medicaid UNDERPAYING doctors, hospitals and other medical facilities.
November 23, 2012 UPDATE Attention young people who voted for Barack Obama’s second term and with it his health care law. Get ready to pay a LOT more for your health insurance as “Community Rating” (a regulatory concept that has failed in every state it has ever been implemented in) is spread across the entire country.
November 18, 2012 UPDATE What drives up the cost of health care and what are SOME doctors doing about it?
November 16, 2012 UPDATE My latest piece. “Governors can and should stop state based exchanges.”
November 14, 2012 UPDATE What’s wrong with the Obamacare exchanges? < Only 8 pages and worth the read.
November 12, 2012 UPDATE Watch Papa John’s and Applebees franchise owners explain the negative impact of Obamacare on their restaurants. This is just the beginning as this disastrous law unfolds around the country.
November 11, 2012 UPDATE States that have already BLOCKED state based exchanges have already blocked $80 Billion in deficit spending. Other states MUST follow their lead and STARVE the PPACA on the state level.
November 9, 2012 UPDATE The PPACA is still vulnerable! A silver lining in the 2012 General Election results is that there are now 30 GOP governors. 14 states have already passed legislation making the establishment of state based exchanges ILLEGAL in their states. Every other Governor should follow suit. Read why here.
November 9, 2012 UPDATE Republican Governors should NOT help implement the PPACA .
UPDATE October 31, 2012 “The Affordable Care Act is NOT a viable solution. It uses the same perverse reimbursement system currently in place. Bipartisan reforms such as those proposed by Paul Ryan and Senator Ron Wyden should be pursued instead.” – The New England Journal of Medicine
UPDATE October 22, 2012 This is a MUST WATCH & MUST SHARE video on the impact of the PPACA. Please allow yourself one hour to watch: “The Determinators” below:
UPDATE October 19, 2012 Last month, I delivered a short speech during which I discussed the illegal action Barack Obama took earlier this year to delay the destruction of Medicare Advantage until after the November election:
Today, Congressman Darrel Issa issued subpoenas regarding this illegal action. Here is a short video explaining how Barack Obama’s health care law – Obamacare – has scheduled the decimation of the Medicare Advantage program.
October 16, 2012 UPDATE Remember when Joe Biden said during the VP debate: “Who you going to believe on Medicare? The AMA and me, or a guy like Paul Ryan VP?” Well Mr. Vice President, guess what? The AMA now supports Paul Ryan’s defined contribution Medicare Reform plan.
October 14, 2012 UPDATE Military-families-get-a-2400-bill-from-obamacare. This is just the beginning. Active duty and retired Military members can expect their TriCare premiums to increase as high as 345% under the PPACA.
October 14, 2012 UPDATE Watch & Read: PPACA could cost 35,000 seniors their lives each year.
October 13, 2012 UPDATE Vice President Joe Biden lied during the debate with Paul Ryan. There are 35 suits & 100 plaintiffs suing the Health and Human Services Department over usurpation of their 1st amendment RIGHTS via the the HHS Contraception & Abortion mandate.
October 9, 2012 UPDATE Click to read: The RATIONING of your health care is beginning. Courtesy of PPACA.
October 7, 2012 UPDATE Click to read: Businesses begin to adapt to the PPACA by ELIMINATING “full time workers.”
September 24, 2012 UPDATE With 17-25 million more Americans soon to be enrolled on to our already bankrupt Medicaid system. Nurses and Physician’s Assistants prepare to assume the role of doctors.
September 19, 2012 UPDATE According to a new study using data obtained from the Internal Revenue Service, the new PPACA tax rules will cost American families and businesses 80 MILLION hours to comply.
September 17, 2012 UPDATE Seniors in these 8 states (Illinois is one of them) will suffer the most from Barack Obama’s historic $716 Billion in Medicare cuts.
September 8, 2012 UPDATE In his convention speech in Charlotte, President Obama vowed to block the Republican Medicare reform plan because “no American should ever have to spend their golden years at the mercy of insurance companies.” But back in Washington, his Health and Human Services Department is launching a pilot program that would shift up to 2 million of the poorest and most-vulnerable seniors out of the federal Medicare program and into private health insurance plans overseen by the states. So while he demonized Paul Ryan’s Medicare reform plan, he is directing HHS to implement the same reform idea in 18 states right now.
September 6, 2012 UPDATE Doctor shortage may swell to 130,000 under the PPACA.
September 5, 2012 UPDATE Why college insurance premiums are skyrocketing.
August 28, 2012 UPDATE On Saturday August 26, 2012 Dr. Rich Ferolo, Dr. Mark Neerhof and I sat down with the French Version of CNN – i>TELE which is owned by Canal Plus Group. They have an audience of 2 million viewers in France, Canada & Switzerland. TRUTH about Obamacare is now INTERNATIONAL. Watch the news report here.
August 26, 2012 UPDATE How the PPACA will ration care to millions of the poor and create an UGLY new profit margin for health insurance. This is PRECISELY how it will happen.
August 21, 2012 UPDATE Brace yourself for the UNPRECEDENTED burden of new taxes and regulations coming YOUR WAY courtesy of the PPACA and the Internal Revenue Service.
August 20, 2012 UPDATE $415 Billion of the $716 Billion in cuts the PPACA has already made to Medicare are reductions in payments to doctors. These draconian cuts are already forcing doctors to stop taking Medicare patients.
August 20, 2012 UPDATE Today we lost the 21st health insurance carrier since the PPACA was signed. And, like the others, Coventry insurance company was gobbled up by a giant. To see some of the other carriers that have either closed, their doors or ceased offering health insurance visit this link.
August 20, 2012 UPDATE Medicare DOUBLE TAXATION will begin on 1.1.2013.
August 17, 2012 UPDATE READ > Why your doctor can’t see you.
August 12, 2012 UPDATE When you hear Democrats repeat ad nauseam that “Republicans want to end Medicare as we know it.” Know that they are repeating PolitiFacts’s 2011 “Lie of the Year”. PolitiFact outlines the many reasons why this is lie.
The simple fact is that Democrats have already ‘ended Medicare as we know it” with the PPACA. In fact, according to the Chief Medicare Actuary – Mr. Richard Foster the PPACA cuts $818 billion from Medicare Part A (hospital insurance) from 2014-2023, the first 10 years of its full implementation, and $3.2 trillion over the first 20 years, 2014-2033. Adding in PPACA cuts for Medicare Part B (physicians fees and other services) brings the total cut to $1.05 trillion over the first 10 years and $4.95 trillion over the first 20 years. This is far, far more than just ‘ending Medicare as we know it”.
These draconian cuts will decimate Medicare for all future generations. In fact, they are already forcing doctors to stop taking Medicare patients. Read the truth here in the Wall Street Journal. Or if you’re a health care policy ‘geek’ like me you can read Mr. Fosters entire assessment here in the 2010 Medicare Board of Trustees Annual Report. Mr. Foster’s actuarial opinion can be found beginning on page 281.
There will be additional cuts under the PPACA to Medicare Advantage, the private option to Medicare that close to one-fourth of all seniors have chosen for their coverage under the program because it gives them a better deal. Mr. Foster estimates that 50% of all seniors with Medicare Advantage will lose their plan because of these cuts. In fact, one of the biggest fallacies promulgated by the political left is that ‘the PPACA isn’t even implemented until 2014′. In reality, there have been many cuts already made to Medicare since the passage of the PPACA. To see the full timeline of Medicare cuts and taxes that have already been implemented and those that are coming click here.
12 million seniors use Medicare Advantage, under which the government pays private insurers to cover seniors. These seniors have more options, and at times more coverage, than standard Medicare customers. But the Obama administration said Medicare was overpaying the private insurers, and so the architects of the PPACA slashed $136 billion from Medicare Advantage to offset the cost of the PPACA.
The Medicare Advantage cuts were to begin in 2013, which would cause many insurers to pull out of the program, thus driving seniors into regular Medicare. Open enrollment [for 2013 Medicare Advantage] begins Oct. 15, 2012 less than three weeks before voters go to the polls.” So the PPACA would kick seniors out of their Medicare program three weeks before Obama’s re-election.
That, of course, would be politically damaging. So President Obama simply took $8.35 billion from a PPACA research fund for “demonstration projects” and used it to delay the brunt of the Medicare Advantage cuts until after the election. This is not only an abuse of the President’s executive power but it is also another broken promise made by President Obama when he said: “If you like your health care plan, you will be able to KEEP your health care plan, PERIOD.”
Now that Mitt Romney has announced that Congressman Paul Ryan is his choice for Vice President you will see and hear the most vicious attacks on Chairman Ryan for his attempt to save Medicare before the program implodes and nothing is left for anyone. Please read this entire article so that you can arm yourself with the facts when presented with these highly emotional but baseless attacks.
The fact is that if you condemn the Ryan/Wyden Medicare reform plan and endorse the Obamacare health insurance exchanges you are a hypocrite. Firstly, the Ryan/Wyden Medicare reform plan will change nothing, nada, zero for current Medicare recipients and it will only affect new Medicare recipients. All current seniors and everyone now over 55 would be left entirely untouched for the rest of their lives, unless they chose to enter Paul Ryan’s new system.
Why are Ryan & Wyden proposing a change to Medicare? Because according to the Chief Medicare Actuary (in the 2012 Medicare Trustees report) Medicare will go bankrupt by 2016 if nothing is done to save it. Worse yet, it is currently ILLEGAL to ‘opt out of Medicare’. This means that ‘Millionaires and Billionaires’ who who do not need Medicare are unable to choose not to take Medicare. With Medicare going bankrupt by 2016, why are we giving Medicare to those who do not need it? The Ryan/Wyden bipartisan plan changes that once and for all. Wealthy Americans will be able to opt out of Traditional Medicare. That fact alone should make one want to learn more.
PLEASE NOTE: This NEW bipartisan Medicare proposal plan from Chairman Paul Ryan (R) and Senator Ron Wyden (D) ENDED the “Voucher” proposal. So, when you hear Democrats use the term “voucher” when referencing Paul Ryan’s Medicare reform plan they are either lying or ignorant of his current proposal.
With that out of the way, let’s examine the hypocrisy.
Under the Paul Ryan (R) & Senator Ron Wyden (D) BIPARTISAN Medicare reform plan (devised in December 2011) Americans UNDER THE AGE OF 55 TODAY will be able to purchase tax payer subsidized health insurance (when they turn 65) inside Government run health insurance exchanges.
Under Mr. Obama’s ‘health care reform’ plan (a.k.a. Obamacare), Americans UNDER THE AGE OF 65 TODAY will be able to purchase tax payer subsidized health insurance inside Government run health insurance exchanges.
You can not endorse the “Affordable Care Act” and condemn the Ryan/Wyden Medicare reform plan. For a critical component of both plans is identical.
Do not allow yourself to be guided by emotions and fear. This is OUR future. As such, we must approach it INFORMED. Learn the TRUTH about Mr. Ryan & Mr. Wyden’s Medicare Reform proposal here.
It’s important to note that only one President in U.S. history has ever cut $716 Billion from Medicare by reducing payments to hospitals, health insurers, home health, and other Medicare providers. That President is Barack Obama. Why did he do so? He did so, in order to fund the largest entitlement in U.S. history. Namely, tax payer subsidized health insurance for the majority of Americans under the age of 65. Many of which are not poor. Not even close.
The truth is both Paul Ryan and President Obama propose nearly the same amount of ‘cuts’ to Medicare over the same period of time. The difference is in HOW these ‘cuts’ are made. President Obama simply reduces the “reimbursement ratios” – how much the government pays to doctors and hospitals for their services. Why is this bad? It’s bad because before the PPACA was even passed. Prominent Medical facilities like the Mayo Clinic in Arizona and other medical clinics have already stopped taking Medicare patients because the reimbursement ratios are already too low!
Realizing this, Mr. Ryan employs an entirely different mechanism. Namely, premium support and competitive bidding. Those under the age of 55 today, would still enjoy exactly the same benefits that those on traditional Medicare have today. However, along with the traditional Medicare program they would enjoy the option of choosing among a selection of government-approved private insurance plans. Purchased within a government run health insurance exchange.
You see, Mr. Ryan (R) and Mr. Widen (D) both understand that Medicare will be bankrupt by 2016. As such, they have proposed shifting part of the burden of paying for our senior’s health care costs to the private sector. By offering seniors the option (along with generous financial premium support) of purchasing alternative Medicare coverage options via a government run health insurance exchange.
Did you notice the difference? Under Paul Ryan and Ron Wyden’s plan. Americans under age 55 today will have the option to purchase alternatives to traditional Medicare when they turn 65. Under President Obama’s plan, which is maintaining the status quo, seniors today will have access to Traditional Medicare for a few more years. And, those age 55 and under today, will have access to nothing when they turn 65. For Medicare will be bankrupt before they turn 65.
Another crucial difference between Barack Obama’s plan for ‘reforming Medicare’ – (cutting hundreds of billions of dollars in reimbursement rates to doctors, hospitals and home health care) and the Ryan/Wyden plan is that the Ryan/Wyden plan contains NONE of the tax increases below that are coming – courtesy of the “Affordable Care Act”. And, because the Ryan/Wyden plan introduces free market competitive bidding into the Medicare arena, instead of simply slashing reimbursement rates to doctors, hospitals and home health clinics. Mitt Romney can has now vowed to RESTORE the aforementioned $716 Billion in cuts made to Medicare by President Obama if elected in November.
If you think that introducing competitive bidding into the Medicare arena – via health insurance companies – is a ‘radical’ idea. You might want to contact President Obama and ask him why he has directed his Health & Human Services Department to implement the same reform ideas in 18 states right now.
Sadly President Obama has proposed zero options to truly reform Medicare and save it for future generations. Even though SENATOR Obama derided President Bush for the same thing in 2005. Watch him say it here:
He also derided John McCain for the same in 2008. Watch him say it here:
You know that $711 Billion in ‘cuts’ to Medicare that President Obama authorized with his “Affordable Care Act”? Those cuts were made in large part to expand the rolls of Medicaid in order to subsidize the ‘poor’. Many of which have never paid a dime into the Medicare trust fund. Many of which are not poor. You see, President Obama had redefined the term ‘poor’. Just as our former Governor Blagoyevich did in my home state of Illinois, where the “Affordable Care Act” is already moving ‘forward’ at break neck speed.
PPACA Medicaid Expansion Sections 1311, 1321 and 1401 of the Obamacare legislation mandate Federally subsidized “premium tax credits” for “Obamacare insurance exchange” enrollees. Beginning in 2014, Americans who are not offered health insurance through their employer and who are not eligible for Medicaid may be eligible for premium credits for coverage through an “Obamacare health insurance exchange”. The Obamacare legislation massively expands our already bankrupt Medicaid rolls (at an additional cost to state tax payers of at least $118.04 Billion by 2023) to an estimated 16-25 million more Americans. The legislation also calls for extremely generous tax payer funded ‘premium assistance’ to individuals and families with income between 138% and 400% of the Federal Poverty Level.
Using 2012 Federal Poverty Levels, this would mean that individuals in 48 states & D.C. making $42,680 annually and families of four making $92,200 would now qualify for ‘premium assistance’ from the few, the proud, the 53% of us who actually pay income taxes. Just how much assistance? Take a look at the real cost of Government approved health insurance using Kaiser’s new ‘Health Insurance Exchange Calculator’. Then look at the amount the insured will actually pay. Where will the money come from to expand to pay for all of this? No worries, remember it’s all “free”!
Another problem is that Obamacare freezes our state’s (and other states) Medicaid eligibility requirements regardless of the impact on Illinois’ bottom line. PPACA freezes our state’s (and other states) eligibility requirements regardless of the impact on Illinois’ bottom line. Not only is Illinois forced to keep eligibility at that level, but Illinois is also forced to raise payments to primary care physicians. Section 1202 of H.R. 4872 a.k.a. the “Health Care & Education Affordability Reconciliation Act of 2010” (which was used to pass the PPACA) requires that Illinois increase Medicaid reimbursement rates for primary care physicians to the same level as the applicable Medicare reimbursement rates for years 2013 and 2014.
At first this sounds like a good idea however, this requirement, along with the federal funding for it, expires on January 1, 2015. Leaving the state of Illinois tax payer holding the bill to maintain this new physician reimbursement or make drastic cuts. It is crucial to understand that this new burden placed upon the Illinois tax payer is in addition to the already unpaid Medicaid bills piling up in Illinois after lawmakers enacted a budget pushing $2.4 Billion of last year’s bills into this year. On January 30, 2012, the Civic Federation released its “Budget Roadmap” for the coming fiscal year. In it, they highlight the fact that state officials now believe the Medicaid program will have between $21 and $23 billion in unpaid bills by 2017.
Medicaid patients are already suffering from Illinois’ low reimbursement rates and long payment delays. Nursing homes and hospitals are running out of time and money while they wait for reimbursement. Doctors are turning away poor patients or making them wait weeks or months or even longer to receive care, just to keep their doors open.
What caused our Medicaid system to become so fiscally unsustainable? During Democrat Governor Rod Blagojevich’s Governorship, our Illinois Medicaid program was expanded far beyond simply providing health insurance for children of the poor (which was the original intent of the bi partisan Federal SCHIP bill). Blago expanded our Medicaid based state health insurance program to include 2 new programs that were designed to ‘supplement’ our “All Kids Covered” (www.allkidscovered.com) program (formerly “Kid Care”). These two new Medicaid based Entitlement programs (still in existence today) are called “Family Care” (www.familycareillinois.com) and “Mom’s & Babies” (www.allkids.com/pregnant.html). These programs go far beyond providing health insurance to children of the poor. In fact, they provide ‘free’ to nearly ‘free’ health insurance coverage for pregnant women and even the Father of a child who is enrolled on our “All Kids Covered” program. The program was also expanded to include coverage for those far beyond the existing Federal poverty levels.
Adding to the rapid bankruptcy of our Illinois Medicaid program was the fact that under Blago’s Governorship, legal residency status was not required on the Illinois’ “All Kids Covered” Medicaid application. It took an investigation conducted by former Chicago Tribune reporter Dennis Byrne to determine just how many illegal aliens were enrolled on our “All Kids Covered” program. The shocking answer was 75%.
Sadly, as of August 2012 there are no plans, not even a discussion, to purge our bankrupt Illinois Medicaid rolls of more than 77,000 Illegal Aliens. Not even after Governor Quinn passed the new “Medicaid Reform” bill of 2012. Hey, you know what? This sounds GREAT. Let’s expand this concept EVERYWHERE! That is exactly what the PPACA does.
The PPACA simply repeats the same mistakes already made by our now bankrupt (and deeply in debt) Illinois Medicaid program. However, it does so, on a national level. It increases Medicaid eligibility to almost every American with incomes below 138% of the federal poverty level (under the age of 65). This means that a family of four with an income as high as $87,000 would receive ‘premium tax credits’. What does this mean in dollars and cents? A report released by the Centers for Medicare and Medicaid Services shows the impact this massive expansion will have: “This expansion, together with greater participation by individuals eligible under current rules, is projected to add 14.9 million people to enrollment in 2014 and 25.9 million people by 2020—26 percent and 44 percent, respectively, compared to pre-Obamacare estimates.”
This means that by 2020, Medicaid enrollment will reach 85 million, or approximately one in every three Americans. Currently one in every five Americans are on Medicaid. This level of Government dependency distorts the original purpose of the Medicaid program, which was intended to serve as a safety net for only the truly indigent.
As a result of the expansion, the report shows, Medicaid spending between 2011 and 2020 will increase under the PPACA by $619 billion. The federal government will initially pay for most of the new spending, totaling $572 billion. But the expansion will increasingly strain state budgets as well, since the federal contribution decreases rapidly leaving the state tax payer holding the bill. In fact, this massive expansion of Medicaid will bring total state Medicaid spending to $2.3 trillion through 2020. Illinois’ share will be another $10 Billion by the year 2020.
Besides creating a state budgetary crisis like our nation has never experienced before. This massive expansion creates a much more serious problem. A problem that places our nation’s seniors in great peril.
The worst part about massively expanding our already bankrupt Medicaid rolls is that according to a 2009 large and comprehensive study completed by the University of Virginia, and an earlier study completed in 2005 by the American Academy of Cardiology, surgical patients on Medicaid are 97% MORE LIKELY TO DIE than those with private health insurance. Why? Because the reimbursement ratios to doctors who take Medicaid are so low that these patients do not get the follow up care they need after surgery. Keep in mind, BOTH of these studies were completed BEFORE we enroll 25 million MORE Americans onto our bankrupt Medicaid rolls. And, according to the Chief Medicare Actuary Obamacare reduces the reimbursement ratio that the government pays to doctors who take MEDICARE to LESS than it currently pays to doctors who take MEDICAID. And they criticized Sarah Palin for using the term “Death Panels”?
Those who will SUFFER the MOST under the PPACA will be our nation’s poor. Here are the reasons why. Worse yet, this massive expansion of Medicaid will lead to an UGLY new profit margin for health insurance carriers.
I spoke about these 2 studies as well as who will bear the massive COST of paying to insure 25 million more Americans on Government approved health insurance at the 2011 Chicago Tax Day Tea Party:
IPAB – Independent Payment Advisory Board:
Perhaps nothing in the PPACA legislation embodies the top-down, command-and-control nature of Progressive healthcare more than the Independent Payment Advisory Board (IPAB), a 15-member panel of “experts” to be appointed by the President. There are three particular features of the IPAB that illustrate this fact: The IPAB will control all healthcare spending, public and private. The IPAB has been awarded near-dictatorial power. And the IPAB is designed to be a nearly immutable entity.
The IPAB Will Control Everything
While the IPAB has several duties, the chief amongst these is to impose a final, insuperable cap on healthcare spending.
Obamacare hands the IPAB the authority to cap not only public healthcare spending, but also private healthcare spending (thus demonstrating, once again, that Progressives do indeed mean to restrict private healthcare spending). This particular feature of the IPAB is one of the more difficult-to-tease-out aspects of the Obamacare legislation, so it is fitting that the IPAB acquired this sweeping authority in a suitably convoluted and sneaky way.
Anyone who paid attention to the remarkable process that brought us our new and transformational healthcare system might recall that Obamacare was not passed in the usual manner. It began typically enough; there were separate House and Senate bills, each of which passed in their respective chambers (though without any Republican votes). Normally, the next step would be to send those two bills to a Joint Conference to hash out the differences, and then off to a final vote. This did not happen with Obamacare.
The main hangup occurred in the Senate. There, the President needed 60 votes to assure final passage of his bill. And in the way of negotiating for those necessary 60 votes, five or six Democrat Senators went behind closed doors to cobble together a list of amendments to the original Senate Bill – the so-called Managers’ Amendments. It is in the Managers’ Amendments that one can find such famous niceties as the bribes paid to Nebraska and Louisiana in order to entice their respective Senators to support the bill. Some of the deals made behind closed doors were so outlandish that even the Managers themselves (according to many reports at the time) did not expect them to survive the Joint Conference that everyone assumed would take place.
The original Senate bill, before the Managers’ Amendments were added, never created anything called an Independent Payment Advisory Board. Rather, in Section 3403 it created the Independent Medicare Advisory Board, whose powers (appropriately) were limited only to federally funded healthcare programs, such as Medicare. It was the Managers’ Amendments which re-empowered the IMAB, and re-christened it as the IPAB.
Specifically, Section 10320 (in the Managers’ Amendments portion of the legislation) grants the IPAB, beginning in 2015, the authority to limit all healthcare expenditures, that is, all healthcare expenditures, and not just expenditures by Medicare or government-run programs.
To emphasize this expanded authority, Section 10320 changes the name of the “Independent Medicare Advisory Board” to the “Independent Payment Advisory Board.” It directs the IPAB, at least every two years, to “submit to Congress and the President recommendations to slow the growth in national health expenditures” for private healthcare programs. Furthermore, it designates that these “recommendations” may be implemented by the Secretary of HHS or other Federal agencies “administratively” (that is, without any action by Congress).
The justification for this mind-boggling expansion of the IPAB’s authority, to the extent that any justification was offered, appeared to be that controlling private healthcare expenditures will directly impact Medicare, since the “target” Medicare growth rate (which the IMAB was originally charged with achieving) will be determined by overall healthcare expenditures. Therefore, it is necessary to control all healthcare expenditures, public and private. (More practically, if Medicare patients are subjected to arbitrary cost-cutting measures that do not affect younger Americans, we Old Farts are likely to become inconveniently rowdy.)
Once the Managers had devised sufficient paybacks in the Managers’ Amendments to get the needed 60 votes, and the Senate bill finally passed, President Obama and his Congressional allies, Mr. Reid and Ms. Pelosi, determined that allowing the new law to go to Joint Conference would be counterproductive. Support among Democrats in the Senate was so tenuous that party leaders realized the bill would never survive another Senate vote after a Joint Conference. It would be easier, they calculated, to ram the Senate bill, fully intact including the Managers’ Amendments, through the House of Representatives, employing the always-useful reasoning that passing the law right then was a manifest emergency. So that is what they did. And while the vote was also a much closer call than Democrat leaders would have liked, the Senate bill finally passed in the House. And in this way, to the astonishment of many, the Senate bill, Managers’ Amendments and all, became law.
However convoluted the process may have been, the fact is that Obamacare grants the IPAB, a non-elected entity within the federal government, the authority to limit all healthcare spending, including private spending.
The IPAB’s Authority Is Nearly Dictatorial
A quick reading of Section 3403 might leave one with the impression that the IPAB is a sort of Mr. Rogers of healthcare – a mild-mannered, friendly, always-helpful, but ultimately undemanding agent for good. This is the impression imparted by the first few paragraphs of the Section, which paint the new entity as an “advisory” board, whose main task is to develop “proposals” and “advisory reports,” which “proposals” and “advisory reports” would solely consist of various “recommendations,” that ought to be “considered” for the purpose of cost reduction.
Nothing could be further from the truth. This language is simply another example of supplying a new law, which is far more radical than the authors would like people to know, with a soothingly misleading introductory paragraph. The IPAB is actually designed to be as all-powerful as it’s possible to be.
Each year, once the Medicare’s Chief Actuary determines that the projected per capita growth rate for Medicare exceeds the designated target growth rate (which is an inevitability), the IPAB is required to submit a plan which will cut healthcare costs sufficiently to bring the growth rate back in line; which is to say, the IPAB will determine what will be paid for and what will not. Then, the Secretary of HHS is required to implement the IPAB’s plan in its entirety, without exception – unless Congress acts to block implementation. However, the ability of Congress to do so is severely limited. The representatives of the people are forbidden from taking any action “that would repeal or otherwise change the recommendations of the Board,” unless it: a)votes to halt the IPAB mandates with a SUPER MAJORITY of the Senate; and b: devises its own specific cost cutting scheme that will achieve equivalent results. If Congress had the will to do such a thing, however, we never would have needed Obamacare in the first place.
Most worrisome is the fact that if these 15 unelected bureaucrats can not make their quota of necessary cuts, the decision as to how to do so falls, for the first time in U.S. history, to one person. That person is the acting director of HHS – Health & Human Services. That title is currently held by none other than Kathleen Sebellius. A radical left wing, pro abortion, pro eugenics, Liberal.
So, in practice, the cost-cutting “recommendations” which the IPAB will “propose” for “consideration” by the Secretary and by the Congress will be implemented in their entirety, automatically, without revision, and will be backed by the full authority of the Federal government. For all practical purposes, the IPAB will become a new agency of the executive branch with near-dictatorial authority to cut healthcare spending, public and private, where and when and for whom it sees fit.
The IPAB Is Designed To Be Immutable
Section 3403 also contains some remarkable language that likely has never been seen before in American legislative history. To wit: “It shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report that would repeal or otherwise change this subsection.”
So the designers of Obamacare, recognizing that the arbitrary cost cutting that the IPAB will impose on all those ACOs and other integrated healthcare teams (as they happily toil away in the new healthcare worker’s paradise) is sure to create significant political blowback, has sought to immunize the IPAB from any revisionary lawmaking that might result. And as astounding as it may sound, the IPAB and all its designated dictatorial functions are designed by law to be in force for perpetuity. Our Congress has passed legislation that purports to bind all future Congresses from altering it in any way.
We have heard from the President and others that the IPAB is a very important feature of our new healthcare system. This “immutability clause” ought to convince us just how important they believe it to be. This clause necessarily implies that the IPAB is not only the most important innovation in Obamacare, but indeed, it apparently is most important legislative provision ever written. We know this because no other provision has ever received such extraordinary protections from any future alterations whatsoever.
One can only bask in the utter audacity of our Progressive leaders, who are so sure they know what’s best for us that they were willing to engage in all manner of legislative legerdemain to pass Obamacare, not only against the apparent expressed will of the people, but also (as it turns out) against the objections of any future American Congress that is sent to Washington by those people.
Not even our Constitution itself – a document that attempted to establish a government for all time – was as audacious as this. For the Constitution, at least, provided a mechanism for its own alteration.
Source: The Covert Rationing Blog
It’s important to understand that IPAB was modeled after state run health plans like the one in Oregon. Here’s how well that plan is serving the sick and elderly in the state of Oregon. Caution: do not watch this clip without monitoring your blood pressure. Watch: Oregon health plan denies woman cancer medications but offers assisted suicide.
The Complete Lives System It’s crucial to understand the individuals who helped Barack Obama craft Obamacare. One of them is none other than the brother of the current Mayor of Chicago. Dr. Ezekiel Emmanuel. As a Eugenist, he designed something called the “Complete Lives System”. This ‘system’ was designed for government ‘officials’ to decide the ‘appropriate’ amount of health care you should receive based on your age and your ‘value to society’ based on age. The image below is what “Dr. Emmanuel” refers to as the “Reaper Curve”. Take a good look at it, because depending on your age, the future of the American health care system, under systems like this may look very bleak for you. Why? Read about the twisted ‘science’ behind this kind of thinking here in the Wall Street Journal. As you are reading, remember one thing. Dr. Emmanuel was appointed to two key positions in the Obama administration, prior to the passage of Obamacare. Health-policy adviser at the Office of Management and Budget and a member of the Federal Council on CER - Comparative Effectiveness Research - funding for CER & IPAB were provided in the ‘Stimulus’ bill.
UNFUNDED LIABILITIES: Before Obamacare passed into law, our nation’s unfunded liabilities (promises made to future recipients) were $65 Trillion (Medicare – $38 trillion, Medicaid – over $20 trillion, Social Security – $7 trillion). AFTER Obamacare, our unfunded Liabilities total $82 Trillion. That is an additional $17 trillion. Keep in mind that these unfunded liabilities are in addition to our $16 Trillion national debt ($5 Trillion of that, was incurred by Barack Obama). See the disturbing numbers here.
MEDICARE DOUBLE TAXATION: If we do NOT repeal Obamacare Medicare DOUBLE TAXATION will begin on 1.1.2013 and the IRS will be given unprecedented power to collect this and many other new ‘PPACA taxes’.
I sat down with Carol Ann Parisi in the Champion News Talk Radio studio to discuss this in great detail below:
August 11, 2012 UPDATE BEFORE the PPACA, our nation’s unfunded liabilities (promises made to future recipients) were $65 Trillion (Medicare – $38 trillion, Medicaid – over $20 trillion, Social Security – $7 trillion). AFTER the PPACA, our unfunded Liabilities total $82 Trillion. That is an ADDITIONAL $17 TRILLION. Keep in mind that these unfunded liabilities are IN ADDITION to our $15 Trillion national debt ($5 Trillion of that, was incurred by Barack Obama). See the disturbing numbers here.
August 10, 2012 UPDATE My speech at the Americans For Prosperity “Hands Off My Health Care Rally” in Belvidere, Illinois.
August 9, 2012 UPDATE Every story President Obama told about Preexisting Conditions was a LIE. Click here for a break down of all the lies he told including the lie he told about his own mother’s supposed health insurance plan.
The biggest lie President Obama told about preexisting conditions was the story of Otto Raddatz. Here’s the truth:
The truth is there were state based solutions for individuals with preexisting conditions for 15 years before the PPACA was signed into law. That’s right state based solutions. Find out the truth at TruthAboutPreExistingConditions.com
I spoke the truth about preexisting conditions at the 2010 Tax Day Tea Party in Daley Plaza in Chicago:
August 8, 2012 UPDATE The Obamacare ‘Preexisting Condition’ plan has been lauded by the left as a necessary part of health care reform. In my latest piece at AmericanThinker.com I addressed why it was completely unnecessary.
August 7, 2012 UPDATE Why are health insurance premiums so expensive? And, why have health insurance premiums continued to increase after the passage of the PPACA? Find out the truth at this link.
August 7, 2012 UPDATE New study: “PPACA to leave 30 MILLION uninsured.” – Congressional Budget Office.
This, by the way, is more uninsured than there were BEFORE the PPACA:
If you have heard me speak at any event in the last 3 years you know that I have repeatedly warned that millions of Americans would LOSE their health insurance once the PPACA is implemented due to the onerous MLR’s (Medical Loss Ratios) mandated by the PPACA and the more than 100 new mandates placed on every health insurance plan purchased after March 23, 2010. All of this government intervention simply drives up the cost of health insurance for the premium payer (for 90% of American’s this is their employer) and causes smaller health insurance carriers to fold. All of this leaves the consumer with fewer options and higher premiums. Thanks to a recent Gallup poll we now know that 4.5 MILLION Americans have lost their health insurance since the PPACA was signed into law on March 23, 2010. This, of course, is EXACTLY the OPPOSITE of what President Obama promised us. Click here to read more about this disturbing and predictable news.
August 5, 2012 UPDATE According to the most recent CBO (Congressional Budget Office) and the JCT (Joint Committee on Taxation) assessment in July 2012. The PPACA adds $1.08 Trillion in new tax increases. In fact, 21 tax increases will be enacted as part of that law, a dozen of which – target the middle class. Namely, Americans earning less than $200,000 per year for singles and $250,000 per year for married couples. Even though the President made the following promise to the all of us:
Arguably those most onerously affected by these new PPACA taxes will be those who pay the lion’s share of all income taxes in this country – business owners. To find out how small and large business owners will be impacted by the new PPACA taxes visit this link.
Worse yet, the total cost over the first decade for the PPACA has more than tripled from the original $960 Billion initial assessment that President Obama used to ‘sell’ the PPACA to the American people. Now, we know the truth. The actual first decade cost of the PPACA, according to the Congressional budget office will be $2.6 Trillion. Just a wee bit off!
Barrons number 1 rated Independent Financial Advisor and Syndicated Radio Talk Show Host Ric Edelman breaks down just how many new taxes are coming under the PPACA and how they will negatively affect all taxpayers:
August 3, 2012 UPDATE Sadly, it’s not just the taxes that will affect business owners. Do you remember when “Nostrildamus” (that’s what I call Henry Waxman) called for a congressional hearing in order for John Deere and Caterpillar (among other companies) to prove that the PPACA will cost them millions beginning in 2013? Strangely enough, after John Deere and Caterpillar sent electronic documentation proving these additional costs, Mr. Waxman terminated that congressional hearing. Shortly afterwards Lloyds of London published a piece listing more than 80 companies that will taking millions of dollars in losses due to the PPACA. See all 80 companies and their losses here.
August 2, 2012 UPDATE This is a MUST WATCH Congressional hearing on the unprecedented power that the Internal Revenue Service has now been given under the PPACA. There are two parts:
August 1, 2012 UPDATE Today, myself and the vast majority of Americans, REGARDLESS of our religious beliefs begin paying for Abortion inducing drugs.
July 29, 2012 UPDATE My latest piece: “Obamacare has ALREADY increased health insurance premiums and ELIMINATED insurance carriers.”
July 25, 2012 UPDATE My latest piece: “The Impact of the Obamacare ‘Roberts Tax’ on Individuals, Tax Payers and Business Owners.”
July 25, 2012 UPDATE Today the Congressional Budget Office (CBO) & the U.S. Joint Committee on Taxation (JCT) confirmed what America already knows – that the Democrats’ health law is a trillion-dollar tax hike that families and employers simply cannot afford. See their joint report here. The recent Supreme Court ruling left in place 21 tax increases enacted as part of that law, a dozen of which target Americans earning less than $200,000 per year for singles and $250,000 per year for married couples, in clear violation of the President’s pledge to avoid tax hikes on low- and middle-income taxpayers. According to the new CBO and JCT estimates, the gross tax increases in the law now total $1.058 trillionover 2013-2022. That new amount is nearly twice the “advertised” ten-year tax hike amount claimed when Democrats originally pushed the law through Congress just two years ago.
July 16, 2012 UPDATE Many Americans have forgotten all of the broken promises and outright lies told by Barack Obama and his surrogates about the PPACA. Now, there is a convenient slideshow that has them all archived in one place. Click here here to view it.
July 14, 2012 UPDATE Do you remember when Barack Obama made this promise about the PPACA? ”Now I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see ANY form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not ANY of your taxes.” – Barack Obama:
Well, President Barack Obama LIED once again. Here are SEVEN brand NEW PPACA taxes on citizens making LESS than $250,000 a year.
July 11, 2012 UPDATE MUST READ: Why the UNFAIRNESS of the PPACA WILL LEAD to it’s DEMISE.
July 10, 2012 UPDATE WATCH these doctors discuss how they will be CLOSING THEIR PRACTICES by 2014 if the PPACA is not repealed in 2013 via a new Senate and a new President:
July 5, 2012 UPDATE My interview with Chicago’s own Jonathan Hoenig (“Capitalist Pig”) and Bruce Wolf on “the Big 890″ WLS AM radio in Chicago:
July 3, 2012 UPDATE Below are videos of my in studio appearance on Champion News Talk Radio on AM560 WIND radio in Chicago the morning of the SCOTUS ruling on the PPACA.
July 1, 2012 UPDATE Listen to my in depth interview with the infamous “BigFurHat” of www.IownTheWorld.com on Obamacare, the Supreme Court ruling and what it means for all of us:
June 28th, 2012 UPDATE The ruling today by Chief Justice Roberts was an illegal betrayal unlike any we have seen by a Supreme Court justice in 70 years. For those of you who FOOLISHLY believe that “We need time to tell if what Justice Robert’s did was right.” Here’s the TRUTH. The U.S. Supreme Court has ONE JOB and ONE JOB ONLY. That job is to UPHOLD and PROTECT the U.S. Constitution. NOT TO CREATE BRAND NEW TAXING POWERS OUT OF THIN AIR. This is PRECISELY what Robert’s did. There is NO POWER TO TAX “INACTIVITY”. It exists NO WHERE in the ENUMERATED POWERS ‘We The People’ GRANTED to Congress.
This new taxing power Justice Robert’s created is neither a direct tax, an excise tax, a capital gains tax or ANY OTHER kind of taxing power that Congress is ALLOWED under our Constitution. It is a NEW power, written, devised and PASSED into LAW by ONE MAN. The power to tax you for doing NOTHING. There were FOUR Justices who voted to strike down the ENTIRE LAW today – Scalia, Kennedy, Thomas & Alito. The swing vote and a TRAITOR to all Americans was Chief Justice Roberts. To understand why Justice Robert’s decision was so OFFENSIVE, ILLEGAL and TYRANNICAL read this assessment by journalist Robert Moon.
One more comment about today’s ruling. Today, the U.S. Supreme Court CONFIRMED what I have been saying for 4 years straight. Barack Obama is a LIAR. For he PROMISED that his ‘fine’ for not purchasing health insurance is NOT a TAX.
It is this NEW TAX, a TAX FOR DOING NOTHING that WILL RESULT in the LARGEST TAX HIKE on the MIDDLE CLASS in U.S. history. According to the CBO: Obamacare Will Increase Taxes on Middle-Class by $4.2 Billion – $4,667 per Taxpayer:
Regarding “Silver Linings” from today’s decision. There are three. The first is that before today’s decision, states were being threatened to either implement the massive expansion of Medicaid (that PPACA requires) or lose all Federal matching funds for Medicaid in their state. The Supreme Court ruled that this will NOT be allowed. This means that states can now refuse to open PPACA exchanges without fear of losing all Federal Medicaid funding. This is why Governors like Scott Walker and Rick Perry are not saying NO. Read the letter Governor Rick Perry sent to HHS.
Why did Governor Perry send that letter? Because he knows EXACTLY what the PPACA will look like nationwide. The PPACA will add 25 million people onto our already bankrupt Medicaid rolls. This will exacerbate an already serious problem with health care access. Texas doctors are already refusing Medicare & Medicaid due to low pay and red tape.
June 4, 2012 UPDATE The HHS contraceptive ‘mandate’ is WORSE than you think. Share this video
May 31, 2012 UPDATE Must WATCH. “Obamacare and the road to serfdom” h/t John Stossel & Dr. Lee Hieb.
May 28, 2012 UPDATE First it was Mammograms and now the Statist masterminds behind the PPACA believe that screening for Prostate Cancer is a waste of money.
May 8, 2012 UPDATE Why a law called the “Patient Protection and Affordable Care Act” neither ‘protects’ patients nor makes care more ‘affordable’. Thank you Dr. Elizabeth Lee Vliet for this excellent article.
April 22, 2012 UPDATE I spoke the truth about the PPACA at U.S. Congressman Joe Walsh’s health care town hall:
March 28, 2012 UPDATE I discussed the impact of the PPACA on small business for Fox News today:
March 26, 2012 UPDATE The CBO – Congressional Budget Office – finally releases the TRUE cost of the PPACA. Only a few years LATE, how convenient.
March 22, 2012 UPDATE All of the Obamacare “Broken Promises” (a.k.a. LIES) documented in one video:
March 20, 2012 UPDATE Does Obama’s ‘contraception’ mandate REALLY ‘save women’s health’? What is the TRUTH? Get the facts here.
March 12, 2012 UPDATE Starting in 2014, section 1303 of the PPACA legislation will force you to pay for abortions. The exact opposite of what the President promised Michigan Democrat Bart Stupak in order to garner his support.
March 12, 2012 UPDATE New study shows employers passing on massive health insurance premium increases onto their employees. Read study here. My own clients have received premium increases as high as 46% since the passage of the PPACA and we’ve lost more than 20 health insurance carriers as well. To see my client’s actual renewal notices as well as the names of each insurance company we’ve lost since the PPACA was signed into law click this link.
March 9, 2012 UPDATE ATTENTION Active Duty and Retire Military members! Barack Obama is moving you IN TO the new PPACA health insurance beginning after the 2012 General Election (of course). How will this affect you? This will cause your Tricare premiums to INCREASE between 30 percent and 78 percent for the first year. After that, the plan will impose five-year increases ranging from 94% to 345% – more than 3 times current levels.
February 29, 2012 UPDATE How much will the new PPACA ‘exchanges’ cost the already BANKRUPT State of Illinois? The bargain price of only $90 MILLION a year!
February 27, 2012 UPDATE Dr. Jill Vecchio gives an excellent break down of the PPACA legislation in the following 7 short videos. These are a MUST watch.
February 14, 2012 UPDATE Click here for statistical PROOF that the PPACA will RAPIDLY bankrupt States.
February 14, 2012 UPDATE Barack Obama: 3 years in office and 21 tax hikes. Many of them from the PPACA.
February 2, 2012 UPDATE New Medicaid report shows the PPACA will further bankrupt already bankrupt States like Illinois and California. Oh and here’s the BEST part! Starting in 2014 the PPACA starts TAXING ITSELF!
February 1, 2012 UPDATE Catholic Church denounces PPACA “forced Contraception & Abortion pill” health insurance coverage mandate. Read the details here.
It began when the U.S. Health & Human Services Department attempted to mandate that all health insurance policies in this country include new “Preventative Care” benefits as of 8/1/2011. Included in their idea of “Preventative Care” is not ONLY “Contraceptives” that prevent conception which many Christians are NOT opposed to, but also two separate and deadly Abortifacient drugs.
Many Christians are not opposed to “Contraceptive” drugs that prevent the fertilization of the human egg (thus preventing conception, or the beginning of a human life). What the vast majority of Christians are diametrically OPPOSED to is Aborting a human life after conception. This is why the Family Research Council wrote a strongly worded letter to HHS on August 1, 2011 when they first attempted to violate our religious beliefs. You can read that letter here.
Since very few people, besides myself, even knew this was occurring as part of the new health care law it went largely unnoticed. That is, until the Catholic church was notified that they ALSO must comply with this ‘Interim Final Ruling. THEN more than 400 Catholic organizations including the Pope himself RIGHTFULLY condemned the Obama administration for this new usurpation of their 1st Amendment rights. You can read more about the more than 400 Catholic organizations who are pushing back here.
You see, this is FAR MORE than just about “Contraception”. This is about the Government FORCING all Americans including all Christians and ALL Catholics to not ONLY pay for Abortions with U.S. Tax Dollars but to purchase health insurance that includes coverage for Abortions whether it violates their religious beliefs or NOT.
This is an UNPRECEDENTED violation of our 1st Amendment rights and the only response thus far from the Tyrannical Obama administration is “You have one year to comply”. In other words, you have one year to abandon your fundamental religious beliefs and succumb to our rules.
This will NOT stand in America and I can guarantee you all one thing. The Obama administration will walk this ruling back and they will do so quickly or face the wrath of millions of Christians and all TRUE Catholics at the polls in November. This is also why Joe Biden and Bill Daley BOTH practicing Catholics WARNED Obama about this ruling BEFORE it was made http://www.politico.com/politico44/2012/02/biden-daley-warned-president-about-contraception-decision-113881.html
January 23, 2012 UPDATE George Will breaks down just how bad the PPACA will be for States and how this issue will soon be addressed in the Supreme Court. This is a must read!
December 1, 2011 UPDATE New study from the Galen Institute provides empirical data to support nearly every statement I’ve made in every speech I’ve made for the last two years. “A Radical Restructuring of Health Insurance.”
October 31st, 2011. UPDATE Remember those “tax payer subsidies” to purchase health insurance through the new PPACA exchanges? Turns out those subsidies provide a huge financial disincentive for Americans to get married. In fact, divorcing or staying single will be a far more lucrative option after 2014. Click here for more on this.
October 15, 2011 UPDATE Today the Obama Administration made the following statement: “For months opponents of health reform have falsely claimed that the Affordable Care Act would lead to the taxation of health care benefits. The claim wasn’t true when the rumor first surfaced, it isn’t true today and it won’t be true tomorrow. ” Click here to read why that statement is a bald faced LIE.
October 5, 2011 UPDATE Remember when the President said my plan will lower premiums by $2,500 per family? In 2011, the annual health insurance premium for a family of four was pushed above $15,000 for the first time EVER Read the details.
September 23, 2011 UPDATE New study shows waiting times to see a Doctor are about to go WAY up. Read details.
September 19, 2011 UPDATE This report was released by Investors Business daily that revealed that under Section 1311 & 1321 of the PPACA, people who buy health insurance through a federally run exchange will NOT eligible for ANY premium subsidies. Since employers will be incentivized to terminate their health insurance plans and dump their employees into the new PPACA health insurance exchanges (exactly like Massachusetts) this will leave millions of Americans with a hefty health insurance premium. When that happens, it will indeed INCREASE the number of American Uninsured instead of DECREASE the number of American Uninsured. Just as I said it would.
August 1, 2011 UPDATE Second wave of PPACA “Preventative Care” mandates begin including “free” “Morning After” Abortion pills. Reuters reports.
July 5, 2012 UPDATE One page leave behind on PPACA. What we’ve been told about the PPACA vs the TRUTH.
June 21, 2011 UPDATE The CBO (Congressional Budget Office) 2011 “Long Term Outlook Budget Outlook” published 6/21/2011 states that not only will the PPACA not reduce health care costs, but the PPACA’s rapid expansion of Medicaid to nearly 30 million more Americans will drive health care costs to an all time high in the coming decades.
Click here to Read the new CBO study.
May 26, 2011 UPDATE There are now 3,095,593 Americans “waived” from the PPACA. Click here to find out who.
March 22, 2011 UPDATE Watch me debate a Liberal “Progressive” on the PPACA at Rep. Randy Hultgren’s Office. This is a half hour long street debate well worth your time. Every talking point is dismantled and replaced with facts.
January 15, 2011 UPDATE There are MANY lies coming from the Main Stream Media about the costs related to repealing the PPACA. Do NOT believe these lies. Here are the REAL numbers. Repealing the PPACA will save $2.5 Trillion and Medicare will no longer be ROBBED of $4.95 Trillion over the next 2 decades.
January 6, 2011 UPDATE Click Here to read the new Congressional report entitled “Obamacare: The Budget-Busting, Job-Killing Health Care law.”
For 2010 updates on the PPACA a.k.a. “Obamacare” click here.