On July 3, while most Americans were abandoning their cubicles early in anticipation of a long holiday weekend, the Obama administration made an important announcement.
It declared that it would delay enforcement of the employer mandate provision of Obamacare—which forces large employers to provide affordable healthcare for their employees or else pay a significant penalty per worker—by one year.
Sounds like good news, right? Businesses are undoubtedly relieved. But putting aside the questionable legality of selectively enforcing any law (Obamacare, as signed into law, unequivocally requires this mandate to take effect on January 1, 2014), the Obama administration's actions seem strange. Why would a president who has been so hostile to business up until now suddenly decide to grant a reprieve?
Some mainstream media outlets cite the complexity of the law and the need for more time to meet its requirements. Others spin the delay as a deliberate favor to businesses which have been dreading the arrival of the mandate. Still others describe it as political cover for Democrats in the 2014 midterm elections, who don't want to give ammunition to voters opposed to Obamacare.
While each explanation may contain a grain of truth, there is much more to the story, as our guest author will explain.
Elizabeth Lee Vliet, M.D. has been an independent physician since 1985. In 2009, upon realizing that the US was marching toward socialized health care, she took to studying the ins and outs of government-run healthcare systems in places like Britain and Canada. She has been writing and speaking on the topic of Obamacare ever since. As a doctor, she possesses the rare combination of intimate knowledge of both the medical system and Obamacare's provisions, uniquely qualifying her to weigh in on this topic.
Importantly, Dr. Vliet's article today only addresses the tip of the Obamacare iceberg.
The delivery of medical care in this country is changing in unprecedented ways, most of them bad. I interviewed Doctor Vliet about how Obamacare will affect the quality, cost, and availability of medical care, how it threatens patient privacy, and much more in an upcoming The Casey Report special report. Subscribers to The Casey Report will receive this special report in their email boxes later this week.
Dr. Vliet will also be speaking on the topic of Obamacare at our Casey Research Summit on October 4-6 in Tucson, Arizona. She is also co-chair of the Men's Health and Aging Conference, which will be held immediately following our Casey conference in Tucson. Her conference will also focus on how to preserve one's health in the face of increasing government control of medical care. View the conference agenda, and if you're interested in attending, register before August 1 to receive an early-bird discount.
Enjoy, and see you next week.
Managing Editor of The Casey Report
Hidden Consequences of the Employer Mandate Delay
By Elizabeth Lee Vliet, M.D.
Obamacare is a hodgepodge of new regulations, requirements, and penalties. I'd like to start by defining three terms which, while obscure today, should begin to enter our everyday vocabulary as Obamacare continues to take effect:
Health insurance exchanges are the basket of qualified insurance policies that meet the new healthcare law requirements for expanded coverage. These may be set up by the states (many are refusing to do so, due to high cost and fear of bankrupting the state) or the federal government. The Exchanges are supposed to be fully operational by October 1, 2013, but it is questionable whether they will actually be in place by that deadline.
The individual mandate requires that individuals purchase health insurance that meets the new, expanded federal requirements. Individuals who do not comply face a financial penalty. Individuals who fall below minimum income levels will be eligible for taxpayer-funded subsidies to buy health insurance.
The employer mandate requires that businesses with more than 50 fulltime employees must provide health insurance for all employees, and that insurance must meet the new standards set forth in the new law. Businesses that do not comply must pay a financial penalty for each employee, which for large companies can run into the millions of dollars annually. This is the piece of Obamacare that has been delayed by one year.
Why delay one component of Obamacare and not the others? More specifically, why delay the employer mandate but not the individual mandate?
To answer that question, we must first understand this fact: Obama wants a single-payer healthcare system in the US. This is not a secret:
Barrack Obama, 2003: "I happen to be a proponent of a single-payer healthcare system for America, but as all of you know, we may not get there immediately."
Barrack Obama, 2007: "But I don't think we will be able to eliminate employer-based coverage immediately. There is potentially going to be some transition time."
These quotes are not taken out of context. Anyone who has been paying attention knows that transitioning to a single-payer system has been Obama's and his cohorts' ultimate goal all along:
Rep Jan Schakowsky (D-IL), 2009: "Next to me was a guy from the insurance company who then argued against the public option. He said it would not let private insurance companies compete. A public option would put the private insurance companies out of business and lead to single-payer. My single payer friends, he was right. The man was right!"
Here, Rep. Schakowsky is suggesting that the "public option" will lead to their desired goal of a single-payer healthcare system. Single-payer proponents no longer use this term, since the public has clearly and consistently opposed it. The "public option" has been renamed "Medicaid expansion," which serves the public-relations purpose of confusing the public and avoiding calling taxpayer-funded healthcare "single payer."
Jacob S. Hacker (Yale Professor), 2008: "Someone once said to me this is a Trojan Horse for single payer. It's not a Trojan Horse, right? It's right there! I am telling you. We are going to get there. Over time. Slowly. But we are going to move away from reliance on employer-based health insurance, as we should, but we will do it in a way that we are not going to frighten people into thinking they are going to lose their private insurance. We will give them a choice of public or private insurance when they are in the pool. We are going to let them keep their private insurance as long as their employer continues to provide it."
Hacker nicely sums up the underlying goals of Obamacare: not to increase competition or patient choice, but to drive people out of private insurance as a stepping stone to a government-run, single-payer system.
Stepping Stone to Single-Payer
Knowing Obama and his cohorts' goals, the purpose behind the delay of the employer mandate seems clearer: to hurry the "transition time" away from employer-based health insurance and to a single-payer system.
By forcing individuals to purchase compliant healthcare plans but not forcing employers to provide those plans, Obama is creating a swell of 10-13 million workers that must enroll in health insurance, but cannot obtain it from their employers. These workers thus have no choice but to use the government-controlled health insurance exchanges, or else pay a financial penalty. This represents a doubling of the number of workers forced to get health insurance on the exchanges.
Importantly, the IRS has ruled that if workers have access to affordable health insurance through their employer, their dependents are not eligible for taxpayer-funded subsidies on the Obamacare health insurance exchanges. Now that businesses will not be required to offer health insurance until 2015, workers and their dependents will be eligible for taxpayer-funded subsidies to purchase health insurance on the exchanges. This will cost taxpayers an estimated $60 billion dollars in 2014 alone to cover the increased costs of subsidies—and the loss of revenue from employer penalties.
This $60-billion figure is before we take into account the "liar subsidies" that will invariably occur now that the Administration has quietly removed eligibility verification for taxpayer-funded subsidies. Community organizers are already being hired around the country to sign people up for the health exchanges. There are no penalties for failing to verify eligibility, and no penalties for signing up people who cannot afford to pay the monthly insurance premiums. It is set up for disaster, much like the "liar loans" that helped topple the mortgage industry when people were not required to verify their income to qualify for a mortgage.
Remember, by enacting the dual mandates, Obamacare ostensibly was designed to ensure that its costs were borne by businesses, not taxpayers. But when the president decided to enforce only certain portions of the healthcare law and delay others, he shifted the cost of health insurance onto the backs of taxpayers.
This is all on top of the burdensome costs Obamacare has already created. Various studies have projected that private insurance premiums will rise between 20 to 60% in 2014, and some as much as 100%.
How long will the private-insurance market survive with such exploding costs? People will not be able to afford such massive premium increases. That seems to be the point: drive up costs and drive everyone into the arms of government-controlled medical care.
Jeff Smith from Seattle summed it up nicely in a Wall Street Journal letter on June 12:
"I was going to leave my job…to start a business until I shopped around for a healthcare plan: At Group Health, a health-maintenance organization in Seattle, I was given a quote of $842 per month for me and my family. But that would increase to $2,320 starting in January 2014 when Obamacare kicks in—a 276% increase. Why? Because I would be forced to carry coverage I don't want and don't need, such as maternity care. Welcome to the world of socialized medicine, courtesy of the Un-Affordable Care Act."
How Obamacare Affects You and Your Medical Care
The delay in the employer mandate is but one of dozens of negative impacts Obamacare will have on your medical services. As an independent physician, I've been discussing these issues with my patients for the past few years, helping them to prepare for what's ahead. Here the ten most important points that I tell my patients:
- Your private insurance premiums will cost more and more each year.
- You will lose the choices and flexibility in health insurance policies that we have had available up until now.
- As reimbursements continue to drop, fewer and fewer doctors will take Medicare (for those 65 and older) or Medicaid (people younger than 65).
- Fewer doctors accepting Medicare and Medicaid causes an increase in wait times for appointments and a decrease in the numbers and types of specialists available on these plans. Consumers would be wise to line up their doctors now.
- Studies from various organizations and states have consistently shown that Medicaid recipients have longer waits for medical care, fewer options for specialists, poorer medical outcomes, and die sooner after surgeries than people with no health insurance at all. Yet an increasing number of Americans will be forced into this second-class medical care.
- As more people enter the taxpayer-funded plans (Medicare and Medicaid) instead of paying for private insurance, the costs to provide this increased medical care and medications will escalate, leading to higher taxes.
- With no eligibility verifications in place, millions of people who are in the US illegally will be able to access taxpayer-funded medical services, making longer lines, longer wait times, and less money available for medical care for American citizens… unless taxes are increased even more.
- Higher expenditures to provide medical services lead to rationing of medical care and treatment options to reduce costs. This is the mandated function of the Independent Payment Advisory Board: to cut costs by deciding which types of medical services to allow… or disallow. If you are denied treatment, you have no appeal of IPAB decisions; you are simply out of luck, and possibly out of life. This is a radical departure from the appeals process required for all private health insurance plans. Further, the IPAB is accountable only to President Obama, and cannot be overridden by Congress or the courts. IPAB is designed to have the final word on your health.
- Under current regulations, if medical care is denied by Medicare, then a patient is not allowed to pay cash to a Medicare-contracted physician or hospital or other health professional. Patients who need medical care that is denied under Medicare or Medicaid will find themselves having to either: 1) look for an independent physician or hospital (quite rare these days); or 2) go outside the USA for treatment.
- Expect a loss of medical privacy. Beginning in 2014, if you participate in government health insurance, your health records will be sent to a centralized federal database, with or without your consent.
The bottom line is that Americans are losing more and more of their medical freedom. By 2015, so many workers will be trapped in the government-run health insurance exchanges that there will be no going back to the private plans we have today. At this rate, single-payer proponents will drive private insurance companies out of business, which has been their intention all along.
Americans need to become far more proactive about taking charge of their health. The healthier you are, the less vulnerable you are to our degrading healthcare system. It's also wise to consider proactively planning for medical treatment options outside the US.
Dr. Vliet is an independent physician. Upon noticing the major push toward government-run healthcare in the US in 2009, she began studying how government healthcare systems affect the quality and availability of medical care. Her studies led her to become a critic of government healthcare in general and Obamacare in particular.
Dr. Vliet will be speaking on the topic of Obamacare at our Casey Research Summit on October 4-6 in Tucson, Arizona. She is also chair of an international health conference titled "Men's Health and Aging: Preserving Health for the NEXT Stage of Life," which will immediately follow our Casey conference in Tucson on October 6-10. Dr. Vliet's conference will feature international speakers and focus on how to protect your health in the face of increasing government control of your medical care. Click here for the conference's agenda, and click here to register for the conference.
Dr. Vliet's medical website is herplace.com.