When the Affordable Care Act was being proposed, then Speaker of the House, Nancy Pelosi (D, Ca.) opined, “We have to pass the bill so that you can find out what is in it, away from the fog of controversy.” Well, with about half of its provisions being implemented, we are finding out “what is in it.” The bottom line? $813 billion in higher taxes. Married couples earning more than $250,000 per year and individuals earning more than $200,000 per year (some 4.1 million households) will see their tax bills increase 3.8%. Although the upper earners already pay well over 30% in taxes every year, it will be easy for those who agree that “rich people should be penalized” to dismiss these concerns. The fact that such taxes will have a chilling effect on the traditional American ideal of fostering individual success will hardly bother those who believe in the redistribution of income in the Nanny State. But wait. The ACA also imposes new fees on pharmaceutical makers and health insurers plus a 2.3 percent excise tax on medical devices that aren’t sold directly to consumers, such as hip implants and cardiac stents. The law caps the amount of pretax money for flexible-spending programs offered by employers and requires consumers to use pre-tax dollars for over-the-counter medications and finally, makes it more difficult for taxpayers to take itemized deductions for their medical expenses. For those who choose to pay for their own medical care, at whatever their income level, they will be penalized with an excise tax of 40% if their plan is defined by the law as a “high cost” or “Cadillac” plan. All of these provisions will impact most taxpayers, not just the so-called richest taxpayers. The non-partisan Congressional Budget Office estimates that the law will impose additional taxes of at least 27 million dollars on middle class tax payers between 2012 and 2121 as well as adversely impacting the elderly by including a half trillion in cuts to Medicare. The effect of these provisions? Businesses, including health care providers and health insurance companies cannot exist unless they are profitable. The inclusion of expanded health care coverage for children under 26 and the ban on pre-existing conditions, in combination with higher costs will result in providers either getting out of the business altogether or passing the costs on to consumers. It is projected that employers will offer plans with higher deductibles with higher premium payments for participants. From 2010 to 2011, premiums for employer- sponsored family health coverage, for example, increased nine percent. In
addition, with states now getting a green light from the Supreme Court’s decision to opt out of expanding their Medicaid coverage, those who would have been covered will now apparently end up in the insurance exchanges which will be largely funded by taxpayers. Those states that elect to stay in the program will do so only if the additional costs are picked up by the Fed which means by the tax payers. At a time when coverage will be supposedly expanded, no provision deals with the shortage of doctors that already plagues us. This will result in a deterioration of care especially when you consider that the new law will also require even more paperwork as health care providers deal with new levels of bureaucracy at the Federal level created by the law. In addition, it has been pointed out that the enforcement of this law will fall on the IRS which is ill-equipped to deal with the problem as it is already understaffed, not to mention the privacy concerns being raised with expanded intrusion by the IRS into our lives in an effort to identify those evil people to be penalized. Is there any more bad news? Probably but there’s enough right now to make it clear that this law needs to go. Not only do a majority of Americans oppose it ( a whopping 70% oppose the “mandate”) but one of the groups most familiar with our health care, our doctors, also overwhelmingly oppose it. With due respect (and that’s a stretch) to Ms. Pelosi, the “fog of controversy” is not about to go away. Some wags are even suggesting that Chief Justice Roberts, a Republican appointee, who wrote the majority opinion upholding the law, has in effect handed the election to the Republican nominee.