“We have to pass the bill so you can find out what is in it.”
— Former Speaker Nancy Pelosi, March 2010
Now, all the rest of us are going to find out a lot more about what’s in the 2,700-page health overhaul law.
The president now must spend the next four months defending a law that the majority of Americans dislike, and the more they learn about it, the more they dislike it. Worse, the part of the law that is the least popular — the individual mandate — has now been declared a tax.
That’s double jeopardy for the president: The unpopular mandate stands, and it is called a tax. (And this is only one of the 20 new and higher taxes in the law.) Either the president admits it’s a tax as a way of keeping the law on the books, or he says that the Supreme Court is wrong, that it’s not a tax, in which case his law would be invalid.
It’s important to note that the Court did not “uphold Obamacare.” Two specific provisions were being challenged before the Court — the individual mandate and the Medicaid expansion. If either had been struck, then the Court could have decided whether or not to take down the whole law.
Instead, it reached a very narrow decision. The individual mandate is valid as a tax, says the Court. Now, otherwise free citizens will be required to spend our own personal, after-tax money to purchase an expensive private product — $20,000 a year for an average family — or pay a tax. And the Court said the federal government can tell states to dramatically expand their Medicaid programs but that they can’t be coerced with the threat of losing all of their federal Medicaid money if they refuse.
So let’s get ready for the debate. About seven in ten Americans had told pollsters they wanted the Supreme Court to strike down all or part of the health overhaul law. Since it didn’t do that, we all must be armed with the facts as the battles continue at least into November so the voters can issue the final verdict.
Here’s a quick checklist of the ten worst things in the law — in addition to the individual and Medicaid mandates:
1. Employer mandate. Most companies will have to provide and pay for expensive government-determined health insurance for their employees or face federal fines.
2. Anti-conscience mandate. Religious organizations will be required to provide free sterilization, contraceptives, and abortion-inducing drugs to their employees, even if it violates their religious beliefs.
3. New and higher taxes.The law contains at least 20 new taxes totaling $500 billion that will hit medical innovators, health insurance, and even the sale of your home.
4. The Independent Payment Advisory Board. IPAB will still stand, with its rationing power over Medicare.
5. State exchanges. States will be compelled to set up vast new bureaucracies to check into our finances and families so they can hand out generous taxpayer subsidies for health insurance to families earning up to $90,000 a year.
6. Medicare payment cuts. $575 billion in payment reductions to Medicare providers and Medicare Advantage plans will cause more and more physicians to stop seeing Medicare patients, exacerbating access problems.
7. Higher health-care costs. The Kaiser Family Foundation says the average price of a family policy has risen by $2,200 during the Obama administration. The president promised premiums would be $2,500 lower by this year. Hospitals, doctors, businesses, and consumers all expect their taxes and health costs to rise under Obamacare.
8. Government control over doctor decisions.Value-based payments, quality reporting requirements, and government comparative-effectiveness boards will dictate how doctors practice medicine. Nearly half of all physicians are seriously considering leaving practice, leading to a severe doctor shortage.
9. Huge deficits. The CBO has raised its cost estimate for the law to $1.76 trillion over ten years, but that is only the opening bid as more and more people lose their job-based coverage and flood into taxpayer-subsidized insurance. At this rate, the cost will be $2 trillion, not the less than $1 trillion the president promised.
10. 159 new boards, agencies, and programs: The Obama administration will work quickly to set up as many of the law’s new bureaucracies as fast as it can so they can take root before the election.
The November elections are the last hope — we must elect a Congress and a president committed to repealing Obamacare. They, and all of us, will need to be armed with the facts to explain to the American people exactly what is in this monstrous law.
Posted on National Review Online: Critical Condition, June 28, 2012.