The WasteWatcher: The Staff Blog of Citizens Against Government Waste

2014 -- Now We Get to Find Out What is in Obamacare!

The WasteWatcher is the staff blog of Citizens Against Government Waste (CAGW) and the Council for Citizens Against Government Waste (CCAGW). For questions, contact blog@cagw.org.


Happy New Year!  CAGW is pleased to announce that it will reconstitute its Healthcare and Science Division.  Why you ask?  The October 1, 2013 roll-out of the Affordable Care Act (ACA), better known as Obamacare, and the following chaos demonstrated the need for CAGW to increase its focus on health policy.

I’ll be heading up the division as its director and would appreciate hearing from you on what is happening in your state with regards to Obamacare.  Just email me at gotwaste@cagw.org with my name in the subject line - Elizabeth.

Obamacare’s troubles are just beginning.  Certainly, the malfunctioning website Healthcare.gov has been a major issue, along with many faulty state-run websites.  But eventually, as those technological issues are fixed at considerable cost to the taxpayers, it will become clearer that the real problems have always been Obamacare’s policy initiatives.  We will begin to experience those problems in 2014.

Here are some policy concerns we will focus on in the coming year:

  • The president is making changes to the Obamacare law by executive fiat.  What other changes will he make and will Congress try to stop him?  We will call attention to this continuing unconstitutional behavior.
  • Since President Obama will be in office until 2016, what, if anything can Congress do to repeal or replace Obamacare and what could those changes look like?  It is important ensure that whatever policy changes are proposed that they will provide more individual control over healthcare dollars as well as treatment choices, much less government involvement in healthcare, and more transparency for the consumer.
  • For now, governors in 23 states have chosen not to expand Medicaid in spite of Obamacare’s promise to fund 100 percent of the expansion from 2014-2016; slowly decreasing the federal funding to 90 percent in 2020 and beyond.  They understand it is a terrible healthcare system as it consumes on average 23 percent of a state’s budget; so far that number is growing, and it’s unlikely the federal government will continue to fund in perpetuity the shared cost of Medicaid expansion at the high levels provided for in the law.  If that isn't bad enough, it’s worse for patients as many doctors, particularly specialists, don’t see Medicaid patients.  The low reimbursement rates would make it difficult to keep their practices open and participating in the program is a costly bureaucratic nightmare. We will work to make sure states continue to reject the federal government’s Siren song of accepting temporary federal funding in exchange for expanding Medicaid.  This is even more important in light of a recent study that shows Medicaid patients “use emergency rooms 40 percent more than those in similar circumstances who do not have health insurance.”  This is the exact opposite of what was promised by the president and the authors of Obamacare. There are much better ways to help the poor get good health care.

Meanwhile here are some issues that will come to the forefront in 2014 that could dramatically alter the law’s trajectory. Keep an eye out for them.

  • The administration has been throwing out lots of figures on the number of people who have “enrolled” in Obamacare; the most recent is 2.1 million.  This number is short of the 3.3 million the administration hoped to have enrolled by December 31, 2013.  It is important to note that in a recent hearing, Health and Human Services (HHS) Secretary Kathleen Sebelius admitted under questioning the administration’s definition of an enrollee means a person has “chosen a plan,” but has not necessarily paid the first premium.  In the real world, until the premium is paid, an insurer does not consider a person enrolled.  The administration continues to be evasive about releasing actual enrollment numbers and the demographics.  Congress has demanded that Secretary Sebelius provide PAID enrollment numbers early in 2014.
  • If paid enrollment numbers are much smaller then what has been reported, and most enrollees are older and sicker, the financial stability of the exchanges will be called into question.  The administration desperately needs young people to sign up for Obamacare to help offset the costs of older, sicker Americans.  As of December, indications were young people were not signing up.  They know a bad deal when they see one.  We will soon see if young people continue to stay away.
  • The administration has said approximately 3.9 million people have been deemed eligible for coverage under Medicaid or the Children's Health Insurance Program (CHIP.)  It will not be surprising if many more people have signed up for these government programs than private insurance in the Obamacare exchanges.  Why? Medicaid is perceived as being free or very low cost to the patient, though it is certainly not free for taxpayers.  Plus, legitimate questions have been raised on how many enrollees are truly eligible for these programs.
  • Several lawsuits working their way through the courts could stop a large chunk of Obamacare if they are successful.  Recently, Justice Sonia Sotomayor temporarily blocked a requirement under the ACA that would have forced the Little Sisters of the Poor, an international congregation of Roman Catholic women that serve the impoverished elderly, to provide to their employees insurance coverage for contraception, a mandate that goes against the congregation’s religious beliefs.  Others lawsuits concerning religious freedom are pending, such as Sebelius vs Hobby Lobby Stores, Inc., that could force a change to the contraceptive mandate.  Plus, several cases question the legality of the IRS providing subsidies to people in the federally-run exchanges, a process that litigants believe contradict the law.  CAGW wrote about the lawsuits here.
  • Many of those in the health policy arena expect continued cancellations of health insurance policies because they do not meet Obamacare’s expensive mandates (such as 60-year-old women or 29-year-old single men being forced to purchase health insurance that covers maternity and pediatric care.)  Because President Obama delayed the employer mandate for a year (now scheduled for January 1, 2015), expect to hear of employees getting insurance policy cancellation notices, with a large cohort occurring around October 2014, barring any further rule changes.

Former Speaker Nancy Pelosi said in March 2010 regarding Obamacare that Congress needed to “pass the bill so that you can find out what’s in it.”  This is the year we all get to find out.

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