Obamacare enforcement leads to IRS hires, less money for Medicare patients

Critics of Obamacare have pointed out the different ways it penalizes the middle class. The most important being the many taxes and penalties associated with the new health program. Another is the disincentive it provides to those earning above a certain level by imposing high implicit marginal tax rates on additional earned income in the form of less federal assistance with insurance premiums.

One estimate is that the tax associated with the withdrawal of premium assistance combined with other taxes (income and payroll) could push the effective marginal tax rates on earned income for many low and middle-income households to well above 60 percent.

Obamacare also penalizes married couples as their joint income may disqualify them from any federal assistance with their health insurance premiums. For example, if two people each earned $30,000 annually, they would each qualify for assistance. But if married and their incomes combined, they would not.

The medical profession and Obamacare

While some in the medical profession welcome Obamacare, others resent the growing intrusion by government bureaucrats and health insurance companies into the relationship between themselves and their patients.

A recent survey conducted by the Doctor Patient Medical Association randomly sampled 699 doctors and found that 83 percent of those surveyed have considered leaving their practices because of Obamacare.

The DPMA found that many doctors don’t believe the health care program will lead to better access to medical care for the majority of Americans, especially when reimbursement rates for doctors are so low and there is so much paperwork associated with getting approval for treatment from insurance companies.

Paul Hsieh, M.D., a physician in Denver, Colorado, echoes many of these sentiments. He notes that, “government will gradually start imposing controls on how doctors can practice. Physicians will be increasingly subject to various government ‘comparative effectiveness’ practice guidelines that will specify what sorts of procedures and tests they should (or should not) perform, and what sorts of medications they can (or cannot) prescribe.”

“These measures will be portrayed by government officials as ways of improving quality while reducing costs. But over time, they will also be used as a way to covertly ration medical services,” he said. “The Obamacare plan is based on drastically increasing the degree of government control over medical practice and medical financing decisions that should instead be made by patients, doctors and insurers in a free market.”

Hsieh believes that the “newly created bureaucracies such as the Independent Payment Advisory Panel will be empowered to decide if certain procedures and treatments cost ‘too much’ — and therefore not covered under government programs such as Medicare. If you’re a Medicare patient dependent on the federal government for your health care, then this could amount to the government deciding whether you’ll live or die.”

Obamacare also includes “pilot programs to move away from the current ‘fee for service’ model to a system of ‘bundled payments’ where hospitals and doctors receive a fixed fee for managing their patient’s medical problems,” he said. “If providers can treat the patient for less than that amount, they keep the excess. If the patient’s care costs more, the providers must absorb the loss. In theory, bundled payments will encourage ‘efficient’ care. But in practice, they create perverse incentives for doctors to skimp on care, especially for the sickest patients.”

Medicare and Obamacare

The negative impact of Obamacare on Medicare patients was reiterated by local medical providers as well.

James Whipple, Chief Executive Officer of Marshall Medical Center, said that Obamacare would result in hospitals receiving $1.5 trillion less for care provided to Medicare patients.

“The hospitals and doctors are expected to offset this loss by being paid for care provided to people who presently do not have insurance — but in the future will purchase insurance,” he said. Marshall will be particularly hard hit, said Whipple, because up to 60 percent of their patients are insured under Medicare. “In the next 10 years, we are projecting to lose $60-plus million for the care we provide to Medicare patients.” Adding to this problem is that there is not a large uninsured population in El Dorado County to offset the loss.

“It’s my opinion that because the health insurance tax (penalty) is a fraction of the cost of paying health insurance premiums, many people will remain uninsured, especially if they are healthy. I also predict that many employers will discontinue offering health insurance benefits since individuals will be able to access insurance on their own,” he said.

Obamacare — a government sanctioned monopoly?

While there is little doubt that more low and moderate income people will have access to health care because of Obamacare, questions remain about the quality of that care, its real cost, and who benefits most from passage of this legislation.

In 2009, House Minority Leader Pelosi said, “We have to pass our bill so that you can find out what is in it.” Her statement raises the question of who actually wrote the legislation.

Whipple said that several Congressmen and special interest groups contributed to writing the bill. During Congressional hearings, different members claimed credit for it including Rep. Anthony Weiner and Sen. Max Baucus. However Baucus publicly credited his chief health counsel, Liz Fowler, as being responsible.

Fowler was previously the Vice President of Public Policy for WellPoint, the largest health insurer in the country. Baucus said Fowler put together a White Paper in November 2008 that became the blueprint for almost all the subsequent health care measures in both the Senate and House of Representatives.

Commenting on this, PBS journalist and commentator Bill Moyers noted that Fowler was “Vice President of Public Policy. And now she’s working for the very committee with the most power to give her old company and the entire industry exactly what they want: higher profits, and no competition from alternative non-profit coverage that could lower costs and premiums.”

Moyers went on to note that the woman who was Baucus’s top health advisor before he hired Fowler was Michelle Easton. After she left working for Sen. Baucus, she went to work for WellPoint as a lobbyist.

“The health insurance industry alone has six lobbyists for every member of Congress and more than 500 of them are former congressional staff members,” said Moyers. In 2009, “the health care industry … spent $380 million on lobbying, advertising and campaign contributions. And a million and a half went to Baucus.

“Over the last two decades, the current members of the Senate Finance Committee have collected nearly $50 million from the health sector, a long-term investment that’s now paying off like a busted slot machine.”

So the question is who will really benefit from Obamacare? A captive population forced to pay for a program that many never wanted?

Or those in the health care industry who have just been granted a monopoly and guaranteed income stream in perpetuity in return for campaign contributions, i.e., bribes, to Washington politicians?

Contact Dawn Hodson at 530-344-5071 or dhodson@mtdemocrat.net. Follow @DHodsonMtDemo on Twitter.

Dawn Hodson

Dawn Hodson covers news and features.

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