Health Care Prices, Government Instituted Single Payer Plans and Political Answers to Economic Problems

Medicaid Block Grants v. Current Funding Program: Reversing Perverse Politico Incentive System

ACA/Obamacare: Spending Figures Released on the Medicaid Component of Obamacare

‘WASHINGTON (Reuters) - One part of the Affordable Care Act is going according to plan, with U.S. states receiving and spending more money on the Medicaid health insurance program, a report released by the National Association of State Budget Officers on Thursday showed.’

‘"The large increase in federal funds to states in fiscal 2014 was almost solely due to additional Medicaid dollars, mainly resulting from the expansion of Medicaid in a majority of states under the Affordable Care Act," the association found. "While federal Medicaid funds to states increased $41.8 billion in fiscal 2014, all other federal funds to states are estimated to have declined $3.4 billion."‘

‘Medicaid spending rose the most of all states' budget areas, increasing 11.3 percent in fiscal 2014, but the federal government shouldered most of the burden. Federal funding for Medicaid increased 17.8 percent, and state dollars directed to the program only grew 2.7 percent, according to NASBO.’ - U.S. states get more, spend more on Medicaid under Obamacare: report, 11/20/2014, yahoo news.com

Link to the entire article appears below:

http://news.yahoo.com/u-states-more-spend-more-medicaid-under-obamacare-051651014--business.html

ACA Statistics and the Reported Medicaid “Eligible”

“Federal health officials announced on Wednesday that some 1.2 million people selected plans on federal or state exchanges during the months of October and November. That included 803,000 people who applied to the exchanges and were found eligible for Medicaid or a related Children’s Health Insurance Program that provide public insurance for the poor — in addition to nearly 365,000 people who chose private plans.” - Medicaid Outpaces Private Plans, NYT Editorial Board, 12/16/2013 (1)

　

The above is merely an example of a reference to the amount of people applying for Obamacare yet are found to be Medicaid eligible. Further, the above excerpt is somewhat correct in that: “…were found eligible for Medicaid or a related Children’s Health Insurance Program…”. That is, they were not enrolled in Medicaid, they where merely found eligible. Then again, many found “eligible” are not. Moreover, the term “eligible” is a bit misleading as the term “identified” is the correct term. (2)

Many news stories seem to implicitly assume ACA web sites determine eligibility for enrollment into Medicaid and/or the reader comes away with the impression that Medicaid enrollment is spiking. That is likely not the case. How so?

If one goes onto the Obamacare exchange aka “market place” one might very well be identified as eligible for Medicaid. The key is “identified”. The marketplace/exchange has no ability or authority to enroll those identified into any Medicaid plan. The process is to “identify” individuals that appear to be eligible then send contact information to the state of residence of such individual, specifically to the state Medicaid Department, of those identified, to determine eligibility for Medicaid.

If one lives in the states that did not expand Medicaid, via the Supreme Court ruling in their favor, then a narrative appears on the exchange web site stating your state did not expand Medicaid. Hence the number of Medicaid identified ("eligible") one sees in a news reports should be in the states that expanded Medicaid under Obamacare. (3) (4) (5)

Next one needs to consider “identified” vs. “eligible” are worlds apart. One would need to go through the eligibility paperwork [bureaucratic forms of confusing nature] and the application reconciled, reviewed, etc. by the bureaucracy. Stated alternatively, the “identified” becoming “eligible” is a long arduous process.

One must also consider the logistics of haggard state Medicaid Departments having the time to make outgoing contact with the “identified”. Such departments already have case loads and the time available to follow up is surely at a premium. Even then, is the contact follow up information correct?

Next comes the historical percentage of Medicaid eligible that actually follow through and apply for Medicaid. The national historical average of those eligible for Medicaid that actually apply for Medicaid is 61.9%. (6)

One should consider that any number of “eligible” Medicaid recipients in a news story is really the “identified” and the number reported should be discounted heavily given the “identified” vs. “eligible," the “identified” being determined eligible and the process thereof and finally the historical percentage that actually apply vs. eligible.

　


Notes:



(1) Medicaid Outpaces Private Plans, NYT Editorial Board, 12/16/2013.

http://www.nytimes.com/2013/12/16/opinion/medicaid-outpaces-private-plans.html?_r=0


(2) Brokers are reporting that some of their clients are in insurance limbo as they wait for the error to be corrected by HHS or their states, USA Today, 12/09/2013

http://www.usatoday.com/story/news/nation/2013/12/08/healthcaregov-medicaid-eligibility-questions/3871113/


(3) After Supreme Court ruling, Medicaid expansion faces uncertainty, Christian Science Monitor, 01/29/2013

http://www.csmonitor.com/USA/Politics/2012/0629/After-Supreme-Court-ruling-Medicaid-expansion-faces-uncertainty


　

(4) Why States Have a Huge Fiscal Incentive to Opt Out of Obamacare's Medicaid Expansion, Forbes, 07/13/2012



http://www.forbes.com/sites/aroy/2012/07/13/why-states-have-a-huge-fiscal-incentive-to-opt-out-of-obamacares-medicaid-expansion/




(5) Why States Are So Miffed about Medicaid — Economics, Politics, and the “Woodwork Effect”, Benjamin D. Sommers, M.D., Ph.D., and Arnold M. Epstein, M.D., N Engl J Med 2011; 365:100-102 July 14, 2011 DOI: 10.1056/NEJMp1104948



http://www.nejm.org/doi/full/10.1056/NEJMp1104948


(6) Why States Have a Huge Fiscal Incentive to Opt Out of Obamacare's Medicaid Expansion, Forbes, 07/13/2012



http://www.forbes.com/sites/aroy/2012/07/13/why-states-have-a-huge-fiscal-incentive-to-opt-out-of-obamacares-medicaid-expansion/

Obamacare Provider Networks: The Networks Look Like Medicaid Networks? One has Signed Up for “Medicaid Plus“?

‘Many plans being offered now on the new insurance exchanges sharply limit the number of hospitals where services are covered, according to a new McKinsey & Co. report. Insurers are making a bet that price is more important to consumers than choice, and limiting the number of hospitals and doctors allows them to keep the cost of a plan as low as possible. Many of the new plans offered still are more expensive than current plans because they offer more benefits.’

‘According to the McKinsey report, which looked at federal and state-run insurance exchanges in 20 cities including Los Angeles, Atlanta and Houston, about 60% of health plans offer coverage at a smaller number of hospitals than comparable current individual plans. McKinsey identified 120 health plans in those markets by examining federal and state exchange filings, as well as provider information listed on individual insurer and hospital websites. Some of these new plans limit coverage to one or two large hospitals.

The number of hospitals accepting insurance from a consumer who buys coverage on the exchange could be 60% lower than the number of hospitals in current individual plans, according to the McKinsey report, which included the 20 largest hospitals in each market that it measured.

Consumers can still buy plans on the exchanges that offer coverage at a wide network of hospitals, but they cost significantly more, McKinsey said. In a market where the same insurer offers two separate plans—one with broad hospital access, one with limited options—the more comprehensive coverage costs 26% more, McKinsey said.’

‘Leading research and teaching hospitals, such as Cedars-Sinai, the University of Chicago Medical Center and MD Anderson Cancer Center in Houston, are cut out of most plans sold in their home states. That move "is built on the premise that hospitals are commodities," said Thomas M. Priselac, CEO of Cedars-Sinai Health System, which is available on just one of seven middle-tier plans sold in Los Angeles. "That's just not true."‘

‘Consumers who need complex procedures like heart transplants will still be able to get them because their insurers will contract with hospitals that offer them.

Still, "when you need an organ transplant, it's a matter of life or death—do you want your insurance company calling us, working out a deal?" asked David T. Feinberg, CEO of the UCLA Hospital system, which includes Ronald Reagan. The hospital is included in just two of seven middle-tier health plans sold in the Los Angeles market.’ - Shrinking Hospital Networks Greet Health-Care Shoppers on Exchanges, WSJ, 12/13/2013

Link to entire article appears below:

http://online.wsj.com/news/articles/SB10001424052702304202204579256621005722460


　

　

　

　

　

　

　


　

Obamacare Exchanges Offer Medicaid-Type Provider Networks? Glorified Medicaid?

“Think of an insurance plan as having three main components: (1) a premium, (2) a list of covered benefits and (3) a network of doctors, hospitals and other providers. Under the Affordable Care Act, there is very strict regulation of benefits—right down to free contraceptives, questionable mammograms and non-cost-effective preventive procedures. At the same time health plans have been given enormous freedom to set their own (community rated) premiums and choose their own networks. They are using that freedom in yet another way to attract the healthy and avoid the sick.

In the ObamaCare exchanges, the insurers apparently believe that only sick people (who plan to spend a lot of health care dollars) pay close attention to networks. Healthy people tend to buy on price. Thus, by keeping fees so low that only a minority of physicians will agree to treat the patients, some insurers are able to quote very low premiums. They are banking on attracting the healthy and they may even have the good luck to scare away the sick.

Community rating is what makes this strategy work. In the ObamaCare exchanges, if I am healthy why wouldn’t I buy on price? If I later develop cancer, I’ll move to a plan that has the best cancer care. If I develop heart disease, I’ll enter a plan with the best heart doctors. And these new plans will be prohibited from charging me more than the premium paid by a healthy enrollee. (See a more comprehensive analysis.)

As a result, we are getting a race to the bottom on access—with private plans in the exchanges looking increasingly like Medicaid, just as they do in Massachusetts.

The Obama administration doesn’t seem to be bothered by this development. In fact they have been touting the fact that the premiums have been lower than expected, even though the reason is that the networks are narrower and skimpier than expected.

Think how different this is from what we were promised. During the 2008 election, every serious candidate for the Democratic presidential nomination repeated the “universal coverage” mantra repeatedly—and on the left “universal coverage” means universal access to care. No candidate even hinted that access to providers might not be any better than it is under Medicaid. - Obamacare’s Insurance Exchanges Will Foster a Race to the Healthcare Bottom, John C. Goodman, The Independent Institute, 10/03/2013

Link to the entire article appears below:

http://www.independent.org/newsroom/article.asp?id=4739
 



Updated 11/14/2013:

Think ObamaCare Is Bad Now? It Gets Worse Next Year, investors.com, 11/12/2013

http://news.investors.com/ibd-editorials-on-the-right/111213-678930-millions-with-coverage-at-work-to-lose-their-insurance.htm

 

South Carolina vs. the ACA

Legislators in South Carolina are concerned about the impact of ACA upon Medicaid rolls and subsequent taxpayer money that will be required to fund such expansion of Medicaid rolls. However, the concern doesn’t fit a certain vision, one held by a particular author, hence spawning an article entitled: Insurance Rolls to Rise in State Fighting Plan.

Once past the verbal virtuosity argument, the author assumes the reader knows particular information most readers would not generally know and makes the following statement to support the article’s title:


"Even without a change in eligibility rules, enrollment is expected to grow as a result of the new health care law. The law requires most Americans to have coverage, and officials predict the mandate will prompt more of those who are eligible, but not enrolled, to sign up for Medicaid. " - Insurance Rolls to Rise in State Fighting Plan, New York Times, 09/07/2013 [link appears below]


http://www.nytimes.com/2013/09/07/us/insurance-rolls-to-rise-in-state-fighting-plan.html?_r=0



Maybe filling in the blanks that the author left out is a worthy exercise regarding South Carolina and its concern. People that are eligible for current Medicaid under current rules, where the Federal government pays 57% and the states pay 43%, of those people eligible, it is estimated nationally only 61.9% have ever applied. That is, a pool of 30% exists that could sign up under current, un-expanded Medicaid, which is known as the "woodwork effect". That is, the mandate and penalty [or tax if you prefer] of ACA will cause the 30% to pour out of the woodwork to sign up for existing Medicaid to avoid the penalty/tax.

Problem is, the state is only reimbursed 57% regarding existing Medicaid hence the woodwork effect will bust existing state Medicaid budgets which are already a major budget item (and problem) of most states.


The author, politically/purposely, does not bother to connect the dots between Medicaid expansion under ACA and existing Medicaid. How so? The argument for expanding Medicaid, was not so much an argument as it was an edict. The expansion of Medicaid was forced down states throats with the threat of pulling the existing 57% reimbursement if they did not expand Medicaid per ACA. However such requirement and threat was overturned by the Supreme Court.

South Carolina’s concern, which is a concern shared by many, many states, is as follows:


(1) the woodwork effect will flood state Medicaid rolls hence busting state Medicaid budgets,

(2) the edict of expansion, as once required, albeit reimbursed at 100%, was only reimbursed at 100% until 2020 at which time the percentage would be reassessed,

(3) hence states with Medicaid budgets that are growing by leaps and bounds before ACA did not want the woodwork effect and future reimbursement percentages, which may end up set much lower, to expand their particular Medicaid budgets to the point that they had a duel budget crisis on their hands (beyond the current state Medicaid budget problems).



However, for a moment assume the Supreme Court found the opposite way, and the woodwork effect and the expansion took effect. Then approximately 16 million people, potentially, would have been dumped onto Medicaid rolls and millions more through the woodwork effect. Exactly how many doctors currently accept the price fixing scheme of Medicaid? Exactly what quality of doctor accepts the price fixing scheme? The number of doctors accepting Medicaid is decreasing at an increasing rate.


Considering the above monumental increase in Medicaid recipients and fewer and generally reported, less qualified doctors accepting Medicaid price fixing schemes; exactly what does Wanda Widget receive when she is enrolled in Medicaid? It is the classic: "I have insurance but can't find anyplace that accepts it".

Apparently Mr. Obama and his ilk "hope" things will work out. Yes, hope springs eternal.



Laqueur: (laughing) Hope springs eternal. It's one of the most frequently quoted verses of English poetry. The poet was Alexander Pope, a decidedly cautious man. He had many enemies, and we know from his sister that he never went out into the street without his large, aggressive dog, and always with two loaded pistols in his bag.

http://www.spiegel.de/international/europe/interview-with-historian-walter-laqueur-on-the-decline-of-europe-a-912837.html

ACA and “Insurance Exchanges”: what are they and what do they look like?

There is much discussion of “insurance exchanges” regarding Obamacare. However, precious little is discussed regarding what is an insurance exchange and what does an insurance exchange look like?


The first thing one needs to consider is that of the 37 million uninsured as of 2010, about 14 million will be herded into Medicaid. That is, 14 million have no need for the insurance exchange as they will be 100% subsidized in the form of Medicaid.


Therefore only 23 million, currently, will be concerned with insurance exchanges. The exchange itself will not be a free market exchange, rather a market place with strict government mandated regulation. That is, you will not have the freedom to choose, rather you will have the opportunity to choose from selections of a third party’s choice.

Some shoppers who apply for coverage through the insurance exchange will be heavily subsidized while others will receive no subsidy. Those receiving no subsidy are still free to use the exchange or to look elsewhere. The prototype application is fifteen pages long and requires the calculation of twenty one steps. You can view the application, along with the sixty pages of description of the fifteen page application (No way! Way!) at the link below:

http://cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10440.html

What is not well publicized is the second cohort of subsidies. A second subsidy? Yes, not only is the premium subsidized for many income groups but out of pocket expense under the plan is subsidized. Stated alternatively, once a plan is selected and the premium subsidized, the consequential health-care expenses create out-of-pocket cost sharing between the insurance plan and insured of which the insured’s out-of-pocket expense is subsidized [lowered].

　

The insurance exchange will offer four plans with a fifth plan available for applicants under the age of 30. The insurance plans are known as bronze, silver, gold and platinum with the fifth plan for those under age 30 known as the special catastrophic insurance plan. The four plans for those 30 years of age and up [bronze through platinum] find their names and associated coverage based upon the percent of medical costs paid on average.

Note: an additional plan can be introduced by each state exchange, at the individual state’s option, what is known as the “basic health plan” for people from 133% to 200% above the federal poverty line.

What does the exchange look like? Two health insurance exchanges already exist: one in Massachusetts and one in Utah. The Utah exchange is more of a free market exchange given current insurance regulation with many insurers participating. Massachusetts, on the other hand, only has five state approved insurers offering coverage.

Since Obamacare is modeled after the Massachusetts plan, that exchange will likely give one a better idea what to expect from Obamacare exchanges. The link below is to the Massachusetts exchange known as the Massachusetts Health Connector:

https://www.mahealthconnector.org/portal/site/connector

Obamacare: the "Woodwork Effect" and State Government Medicaid

When one approaches the welfare state from a systemic perspective, one needs to note the participation rate of the various programs offered by the welfare state. A known-known, in the creation and subsequent maintenance of a welfare state, and the “use” thereof regarding welfare state programs, those myriad of programs, is that, in the main, such programs are not utilized by all that qualify. That is to say, if welfare state program X is available, the historical norm is less than all eligible participants will actually apply and gain the particular benefits of welfare state program X. An example is Medicaid where 61.7% of eligible participants actually enroll and gain access to benefits. (1)

An economics question that arises, specifically in political economy and especially in public choice theory is: does the introduction of a new welfare state program W increase the participation in an existing welfare state program X? Stated alternatively, will the historical participation rate of an existing welfare state program accelerate with the introduction of an additional program?

Why would one program increase the participation in another program? Answer: the eligible portion of non-participators in program X are exposed to social welfare program W and learn of eligibility for program X. Hence participant P signs up for W and X -or- enrolls in X rather than W.

A problem arises if government G has budgeted for particular participation rate regarding social welfare state program X. If newly created program W creates more participation in existing program X, then G is in deficit given the budget prediction based on a historical participation rate of program X.

Leaving the blackboard and arriving in real-life, one finds a perfect example in that the newly created welfare state program Obamacare interacts with the existing welfare state program Medicaid. Medicaid expansion and associated eligibility rules for access to the expansion is a center piece of Obamacare. When an eligible participant for Obamacare qualifies for Medicaid as their means to health insurance under the Obamacare scheme, there will be a universe of would-be enrollees that will find they are non-participating eligible under the existing Medicaid program. That is to say, the 38.3% of non-enrollees in original Medicaid (those eligible but not enrolled) will find they need to enroll in original Medicaid not the Obamacare sponsored expansion of Medicaid. Stated alternatively, the would-be enrollee find they qualified under the existing program and must enroll under the existing program not the new program. This particular phenomena has been deemed the “woodwork effect”. (2)

The observation arises that who really cares how participant P receives Medicaid…. as Medicaid is Medicaid. Yes and no. As with all schemes Obamacare creates cascading unintended negative consequences that were not sorted out in the central planning process by supposed experts. What consequence? The Obamacare scheme allows for 100% federal tax dollar reimbursement to state based Medicaid plans for new enrollees based on Obamacare eligibility guidelines for placing the previously uninsured into Medicaid. However, if the would-be enrollee is found to have qualified for original Medicaid, then the federal tax dollar reimbursement under existing Medicaid is only 57%. Ops!

The several and many states, the vast majority thereof, have budget problems of their own. Most states have had to cut back on programs and staff as they over expanded services in relation to revenue as well as promised too many unfunded or under-funded future benefits to existing and retired public sector employees. Further, most state budgets are strained to the maximum to provide current legislated Medicaid benefits. Any expansion of current state based Medicaid is a budget buster. For example, Obamacare Medicaid enrollee X, Y, and Z may find that only Y qualifies for Obamacare-based-Medicaid while X and Z qualify for original Medicaid and hence must enroll in the original plan. The existing state based Medicaid programs suddenly experience massive grown in the original Medicaid program and their budgets skyrocket with limited revenue. What do states cut next to accommodate the flood of enrollees?

The cascading unintended negative consequences created by schemes, Obamacare merely being a scheme, comes with the traditional political dupery and nitwitery. The federal government somehow makes available 100% reinbursement for particular state based Obamacare-Medicaid enrollees. How can 100% be reimbursed if the federal government borrows 40 cents on every dollar? Further, those federal tax dollars are not the government’s dollars and/or some magic pixie dust conjured up out of thin air. Rather the tax dollars are taxpayer dollars. Hence taxpayer D in North Dakota has his federal tax dollar sent to New York and taxpayer N in New York has his tax dollar sent to Nevada and so it goes. Yes, its political dupery and nitwitery to frame money as “federal government reimbursement” when in fact the “reimbursing” is not some third party that has its own revenue stream and then bestows exogenous resources of its own creation. The government creates nothing and merely acts as the transfer agent of your tax dollars. The federal government reimbursed nothing. The federal government merely took something from A and gave it to B.

Beyond the political dupery and nitwitery of the scheme, now comes forth “political patronage”. Governor GG of state S would have to increase taxes many fold to accommodate the new enrollees in Obamacare-based-Medicaid. Governor GG would become very, very unpopular straight away. However, through political patronage, governor GG of state S can align with the political aims of those in power of the central government, acquiesce as it were, and avoid raising state based taxes for Obamacare-based-Medicaid and merely rely on the diffused costs passed onto all fifty state federal tax payers with focused benefits upon his particular state constituents. Hence the political patronage becomes a political constituency building exercise through taxpayer dollars for both governor GG and those in power of the central government.

However, the puzzle palace on the Potomac forgot about the “woodwork effect”. Hence governor GG of state S is faced with raising taxes for the flood of new enrollees in original stated based Medicaid. Oh, the evil of it all! Hence governor GG rationally wants noting to do with political patronage in this particular episode as he can not depend on the purposeful political phenomena of diffused costs passed onto all fifty state federal taxpayers with focused benefits upon his particular state constituents.

Update: Medicaid: Don't Expand a Broken System, Hadley Heath, Independent Women's Forum, May, 2013, Volume 3, Number 5.

http://c1355372.cdn.cloudfiles.rackspacecloud.com/028c67b6-e550-441e-b839-861c18fa41e6/Newsletter%20May%202013%20Proof%202[3].pdf

Notes:

(1) Why States Have a Huge Fiscal Incentive to Opt Out of Obamacare's Medicaid Expansion, Forbes, 07/13/2012

http://www.forbes.com/sites/aroy/2012/07/13/why-states-have-a-huge-fiscal-incentive-to-opt-out-of-obamacares-medicaid-expansion/

　


(2) Why States Are So Miffed about Medicaid — Economics, Politics, and the “Woodwork Effect”, Benjamin D. Sommers, M.D., Ph.D., and Arnold M. Epstein, M.D., N Engl J Med 2011; 365:100-102 July 14, 2011 DOI: 10.1056/NEJMp1104948

http://www.nejm.org/doi/full/10.1056/NEJMp1104948

Nitwitery Warning: Math Quest and ObamaCare. Ops! We Spent the Savings Twice.

“Under Obamacare, Medicare cut's [$500 billion] is transferred into Medicaid to pay for the expansion of uninsured coverage outlined above--but, it is also simultaneously credited as savings to the [Medicare] trust fund.

 The CBO and Medicare's own economic estimators already said the government can't spend the same money twice.”

“…the [independent] public trustee overseeing Medicare and Social Security finances, analyzed Obamacare, and found that it will add at least $340 billion to the national deficit--citing federal accounting practices that have obscured the true fiscal impact of ObamaCare. (1) (2) (3) (4)

Hold on, the CBO said last month ObamaCare would cost 1.76 trillion rather than $940 billion:

“President Obama's national health care law will cost $1.76 trillion over a decade, according to a new projection released today by the Congressional Budget Office, rather than the $940 billion forecast when it was signed into law.” (5)

Then $940 billion becomes $1.76 trillion last month which now becomes $2.1 trillion this month.

Notes:

(1)    Public Trustee Report: Obamacare deficit reduction mostly accounting fraud, Examiner.com, 04/10/2012 http://www.examiner.com/political-buzz-in-national/public-trustee-report-obamacare-deficit-reduction-mostly-accounting-fraud

(2)    New study shows ObamaCare increases deficit, knocking down president's vow, Foxnews.com, 04/10/2012 http://www.foxnews.com/politics/2012/04/09/study-claims-obamas-health-care-law-would-raise-deficit/#ixzz1res8ro73

(3)    HHS Secretary Sebelius admits to double-counting in Obamacare budget, Daily Caller, 03/04/2011 http://dailycaller.com/2011/03/04/hhs-secretary-sebelius-admits-to-double-counting-in-obamacare-budget/

(4)    America Crack Open Your Piggy Banks – Obamacare Costs Revealed, 60plus.org, 04/10/2012, http://60plus.org/america-crack-open-your-piggy-banks-obamacare-costs-revealed/

(5)    CBO: Obamacare to cost $1.76 trillion over 10 yrs, The Washington Examiner, 03/13/2012, http://campaign2012.washingtonexaminer.com/blogs/beltway-confidential/cbo-obamacare-cost-176-trillion-over-10-yrs/425831

SCOTUS and ObamaCare: this week’s schedule of arguments

‘ “Hans von Spakovksy, senior legal fellow and manager of the Civil Justice Reform Initiative at The Heritage Foundation, explains what is in store this week.”

　

"There's three days of hearings, and the Court has very specifically laid out which issues it wants discussed each day," says Spakovsky. "So on Monday at 10 a.m. [Eastern] they're going to start off with 90 minutes of argument about this 145-year-old federal law called the Anti-Injunction Act, and it's a law that basically says that you can't sue to get an injunction to stop a tax from being imposed. The only thing you can do is file suit after you've paid a tax or after you've paid a tax penalty, and then you can sue to try to get your money back."


Spakovsky says arguments on Tuesday and Wednesday will be about the unconstitutionality of the individual insurance mandate.

"The third day is going to be arguing about severability," he adds. "In other words, if the Court finds one or more provisions unconstitutional, does that mean they have to throw out the entire law?"

On Wednesday afternoon, the Court will hear arguments about the claim being made by 26 states that the expansion of Medicaid as called for by ObamaCare is unconstitutional.

The arguments will not be televised, as the Supreme Court decided against that idea -- although Spakosvky says they have never allowed cameras in the courtroom.

"They do release the audio recordings of arguments," he says. "But no, the Court has always been pretty firm, most of the Justices, on not wanting cameras in the courtroom because they believe that that would change the arguments made before them because it would mean that lawyers might be playing to an outside audience, rather than dealing with the specific issues in their cases, and addressing those to the Justices." (Editor's note: According to Associated Press, the court will release audio recordings of proceedings at the end of each day of legal arguments.)

Spakovksy thinks there might be a ruling by the end of the term.

"Well, the term of the Supreme Court ends at the end of June, and normally they issue all of the decisions in their cases that they've heard in the Spring by then," he says. "I suspect we will get a decision by then, but then they could put it off and say We're not going to issue a decision until we come back at the end of Summer. I think that would actually be unusual." ’ - Kickoff at SCOTUS: Legality of ObamaCare, Chris Woodward, Onenewsnow.com, 03/25/2012

　

　

State Debt Threatens ObamaCare?

State governments are broke and some states appear on the verge of bankruptcy. There are plenty of components to the financial woes of the several and many states. One of the components is Medicaid. State budgets are straining under existing Medicaid costs.

ObamaCare is predicated on expanding Medicaid rolls exponentially. State governments would be crushed by the added expense of expanded Medicaid participants and their associated cost. Further, the crushing additional cost would be atop the existing Medicaid rolls that appear unsustainable from a state budget prospective. That is, adding a crushing cost atop an unsustainable cost creates an impossible cost.

Meanwhile, Obama is now taking a position that states can opt-out of ObamaCare as long as they institute a plan exactly like ObamaCare. Huh?

Take four minutes and watch the above video with Larry Kudlow and Governor Sam Brownback of Kansas discussing Medicaid's crushing costs and Obama's new non-proposal proposal.

Richard Foster, the chief actuary of the Centers for Medicare and Medicaid Services

Let's Talk About ObamaCare - Kim Strassel, Wall Street Journal, Political Diary, 01/28/2011

"Their health-care repeal vote behind them, Republicans this week got down to exercising the power of hearings that House control now affords them. And the Obama administration, for its part, got a glimpse of how painful those hearings will prove to its policy causes.

Fresh off of his State of the Union response, House Budget Chairman Paul Ryan plowed into a hearing Wednesday morning on the true costs of ObamaCare -- a public-education service that Mr. Ryan has been performing for much of this past year. Now finally wielding the spotlight, Mr. Ryan called as a witness Richard Foster, the chief actuary of the Centers for Medicare and Medicaid Services. Mr. Foster, whose job is to provide independent economic analysis, confirmed the central charges that Republicans have leveled at the health-care law.

Mr. Foster was asked by California Rep. Tom McClintock to provide true or false responses to two key questions. The first: Will ObamaCare bring down medical costs? Mr. Foster's answer: "I would say false, more so than true." Behind his argument was the obvious -- that because the law now requires coverage for people who weren't covered before, costs will by necessity rise.

The second: Will the law allow people to keep their current health insurance? Mr. Foster: "Not true in all cases." Mr. Foster's office has projected that some seven million members of Medicare Advantage -- which was hurt by the law -- will have to find other coverage. Mr. Foster also took a whack at the slippery accounting that was used to calculate the cost of the legislation.

This isn't Mr. Foster's first time as the health-care party pooper. He's developed a reputation for skepticism about political promises made by members of both parties. His non-rosy projections tweaked the Obama administration during the ObamaCare debate, just as his financial warnings annoyed the Bush administration during the run-up to the creation of its prescription-drug plan. And if Republicans have their way, Mr. Foster will no doubt continue to be in front of the cameras over the coming months."

Socialized Medicine: You've Been "Baucus-ed"

The Max Baucus (D-MT) Socialized Medicine proposal will be voted upon this week in the US Senate. The plan paves the way for the following wonderful attributes:

(a) price distortions, demand shock, and over utilization, leading to long waits for services

(b) two to one pricing scheme with the younger insureds subsiding older insureds,

(c) government making decisions on cost effective procedures,

(d) rationing and cascading rationing due to price distortions,

(e) low out of pocket costs leading to cascading over utilization,

(f) increased costs,

(g) higher taxes passed onto consumers,

(h) reduces benefits to the elderly,

(i) vast expansion of the welfare-state via Medicaid with State Governments picking up the tab,

(j) another un-read, not available to the public, rammed through Bill.


Feeling warm and Fuzzy? Feeling like you will pay more for less?


The half-baked Baucus Bill, scored by the Congressional Budget Office (CBO), based on "conceptional legislative language"is going to save money? The plan supposedly costs $829 Billion dollars over 10 years, yet reduces the deficit by $81 billion over 10 years? Hmmm. Unfortunately, the major increase in taxes are left out of the headline. Increased taxes are a cost savings? George Orwell would be proud: savings equals increased cost which increases taxes, consumers ultimately pay the increased tax, which means you saved money (1) (2) (10). Pure genius it is!

Why is the Baucus Bill half-baked? First of all the Bill will never see the light of day (1). Secondly, the CBO scoring was based on "conceptional legislative language". That means the CBO scored the bill on highly dynamic assumptions that can change at the drop of a hat. Its more like the CBO scored a moving target, the moving target changing in size and scope, with the moving target changing speed as it crosses the horizon. The only scoring approach you can use on a target like that is the old shotgun scoring approach. That is to say, the CBO numbers are basically real, real, real fuzzy math.

Regardless of the validity of the CBO scoring, lets talk new taxes and new fees. That's right, the half-baked Baucus Bill has plenty of new taxes and fees. (1) (2) (10) Like all Politicos, the headline numbers are lauded but the new taxes and fees are buried. Plus national polling shows the majority of Americans will only support health care/insurance reform if no new taxes are involved. (3) Polling also shows that the majority of Americans do not support monetary penalties (tax) for not buying health insurance. (4) (7)

Besides the new taxes and fees, what about those Medicare cuts? They are going to cut Medicare payments, cut corruption in Medicare, yet not reform Medicare? Huh? (5) Those reduced Medicare payments have no effect on the elderly? (6) That the reduced Medicare payments are not an indirect tax on the elderly?

The public has decided that ramming through un-read legislation is ridiculous. After the Spruce Goose of all stimulus plans was voted upon and passed without Legislators reading the bill and the consequential 16% real unemployment rate. Then Cap and Trade rammed through the House of Representatives with out being read by Legislators. The result was the eruption of a major public battle cry: for Legislators to make Bills public, read the Bill, and debate the Bill before voting.

When the House of Representatives made their Health-Care/Insurance Reform public, the blow back from the public was amazing. Matter-of-fact, some one million people marched on Washington D.C. in July with many carrying signs reading "Read the Bill".

Guess what? The Public and Legislators will not get to read the Baucus Bill! (8) Why? Because that would take time, public input, and of course that nasty idea of "debate". These are all considered "time wasters" by Progressives/Socialists who want the Health-Care/Insurance reform Bill passed by Thanksgiving. (9) In other words, more rammed through Legislation. Recognize the song just a different beat?

Saved the best for last. The Baucus Bill adds $37 Billion to State Budgets as it vastly expands Medicaid. That's really good news to State Governments that are already bankrupt. You may find you are a citizen of one of the 50 States. If so, fasten your seat belt. Also enjoy your ride as you will also be subsiding Nevada, Michigan, Oregon, and Rhode Island as they are exempt from participating in the the $37 Billion price tag for five years. Huh? Thank Mr. Harry Reid (D-NV)for that little amendment. (11)

Saved the best-of-the-best for the very last. One of the increased tax revenue items in the Baucus Bill is a tax on "Cadillac Health Plans". Who has these Cadillac Plans? Most Unions negotiate for Cadillac Plans for their members. Oh no! Unions are upset about this tax! Enter the Top Socialist of them all: Charles Schumer (D-NY). The arbitrary dollar figure assigned to Cadillac Plans ($21,000 per year) has been increased to a threshold of $25,000 in Massachusetts and other highly unionized states. (11)

One can only wonder why our Legislators have such a abysmal approval rating and the Public doesn't trust the Government. Go figure.


(1) http://www.foxnews.com/politics/2009/10/07/cbo-release-cost-report-sweeping-senate-health-care-reform/?loomia_ow=t0:s0:a16:g2:r5:c0.103757:b28154894:z0

(2) http://www.americanthinker.com/blog/2009/10/health_care_reform_some_states.html

(3)http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/october_2009/55_oppose_penalty_for_not_buying_health_insurance
(4) http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/october_2009/to_pay_for_health_care_plan_59_say_no_new_taxes_on_those_earning_under_250_000
(5) http://www.heritage.org/Research/HealthCare/wm2641.cfm

(6) http://www.newsmax.com/headlines/armey_healthcare_obama/2009/10/06/269197.html
(7) http://blog.heritage.org/2009/10/07/healthcare-at-what-price/#

(8) http://www.washingtonexaminer.com/opinion/No_-you-can_t-see-the-health-care-bill-8352156-63636167.html#

(9) http://online.wsj.com/article/SB10001424052748703298004574457171293975390.html

(10) http://www.foxnews.com/politics/2009/10/06/b-taxes-senate-health/

(11) http://www.americanthinker.com/2009/10/the_baucus_masterpiece.html#