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The Affordable Care Act


A Research Summary Report By Tania Ballard
MG 460 Directed Study/Research in Management

Instructor Dr. J. Wayne McCain


College of Business
April 20, 2011
NOTICE: This paper does not necessarily represent the opinion of the Administration, Faculty, or Staff of Athens State University.
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The Affordable Care Act, AKA “Obamacare”

The Affordable Care Act (ACA) passed in March 2010 in March 2010 at the insistence of
then President Barak Obama and Democrat-controlled House Speaker Nancy Pelosi has
promised Americans a reduction in healthcare costs along with increased coverage for millions
and a decreased set of limitations and restrictions. This research paper summarizes the major
provisions of the new 1900-plus page law and addresses some important issues raised by what
now appears to be a majority of Americans concerning its constitutionality, empty promises,
private citizen/employer mandates, and what may be increased taxes and elevated healthcare
costs. At best, many view the legislation as a foundered attempt at ‘insurance reform’ rather than
an earnest effort to address the real issues that are driving the spiraling cost of medical care. In
the context of business, this law is anything but ‘business-as-usual’ and may actually result in a
significant addition to U.S. deficit spending, loss of jobs, and a decrease in medical coverage for
many already covered by ‘satisfactory’ health insurance. These concerns are coupled with the
real possibility of increased insurance costs for those already enrolled in employer-provided
This paper is intended to point to issues rather than provide succinct solutions. It is also
written as the author’s interpretation of publically-known facts and opinion’s of professional
legislators on all sides. As such, it does not represent the official position of the Administration,
Faculty, or Staff of Athens State University.
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The Affordable Care Act, AKA “Obamacare”

Do the American people want the

future of health care to be in the hands of a

few politicians; the same politicians that are

making themselves exempt from their own

policies? When it comes to our health care

system, most of us agree that America is

ready for a change. We need a system that

delivers accessible, high quality care, but we can’t achieve this goal with government policies

that attack the foundation of our current health care system which is employer-sponsored health

insurance. The Obama administration and members of congress are pushing legislation to set up

a government run health care system. This government-run system would operate in competition

with private health insurance that is commonly provided by many employers to employees and

their families. Employer sponsored health insurance is the backbone of our nation’s health care

system and if this health insurance is banished this would affect millions of Americans. It has

been stated so many times that the law will reduce the nation's deficit by more than $100 billion

by 2020 and by $1 trillion by 2030. So far there is no evidence to find this statement true. It has

been hard to find any positive information on the bill thus far (Refer to Table 4, page 19 for a

Pros and Cons list).

The health care system in the United States has been a subject of debate for many years

as well as the topic of campaign pledges by many who have run for office. Not long ago, in fact,

President Obama made a campaign promise to make better and more health care services
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inexpensive for all. The Affordable Care Act (ACA), which was passed in March 2010, will be

phased in over the next four years (refer to Table 3 on page 15). These next few statements are

statements that the Obama administration wants the Americans to believe is going to take place

with this new health care plan. Such as, dozens of very important provisions have been applied

already, including small business tax credits, the Medicare recipient drug rebate, the

reinsurance program for retiree coverage, the pre-existing condition insurance plans, the

coverage of children up to age 26 on their parents’ plans, and many more. The current

administration wants it to seem like that whether you get insurance through work, buy it

yourself, have a small business, are on Medicare, or don't currently have insurance, the

Affordable Care Act gives you control to make your own decisions regarding your health

coverage. It is said that the Affordable Care Act makes insurance more affordable by providing

the largest middle class tax cut for health care in history - dropping premium costs for millions

of families and small business owners who are priced out of coverage today. In turn this is

supposed to help 32 million Americans afford health care

and make coverage more affordable for many more.

According to Veronique de Rugy in an article titled “Does

Obamacare Reduce Health Care Spending?” The short

answer is no. Using the Congressional Budget Office (CBO)

data, Figure 1 shows that the Patient Protection and

Affordable Care Act and the Health Care and Education

Reconciliation Act of 2010 have left the cost curve of

federal healthcare spending virtually unchanged over the

next 25 years. The CBO finds that the effect of the healthcare legislation has been to increase
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government spending by $3.8 trillion between 2010 and 2020. From 2020 to 2035, federal

spending under the two projections are equal percentages of GDP.”

The Patient Protection and Affordable Care Act, as improved by the reconciliation bill, is

said to ensure that all Americans have access to quality, inexpensive health care and will produce

the modification within the health care system needed to contain costs. A popular opinion is that

this trillion dollar takeover of health care will just make things worse for Americans.

FIGURE 1 – CBO Data Showing Projected Effects on Healthcare Costs

The plan will add hundreds of billions of dollars to the deficit. It would also mean new

taxes and a huge backdoor premium that will make health care costs even higher, not lower.

Businesses and taxpayers will be stuck paying for a government run plan through higher taxes,

these costs are cost that no one can afford at this time when the economy is facing real

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With so many challenges and problems that so many families are already facing, the

healthcare bill would be another burden for a family, as well as a business. Table 1 lists changes

that will take affect with premiums under the new healthcare bill. According to Michael Tanner

in an article (Bad Medicine 2011), he states, “the biggest businesses, those with more than 100

employees, would see the biggest benefit under PPACA, but even here the benefit would be

minimal. Under the best case scenario, the premiums for a family plan would only increase to

$20,100, compared with $13,375 today, and $20,300 if the bill hadn’t passed. That represents a

savings of $200 over what would have happened if the bill had not passed, but still represents a

$6,350 increase over what the company is paying today. Small businesses would see a premium

increase between zero and just 1 percent less than would otherwise occur. Then again under the

best-case scenario, small business premiums for a family plan would only increase to $19,200,

compared to $19,300 if the bill hadn’t passed, a savings of just $100. But the millions of

Americans who purchase insurance on their own through the non-group market will actually be

worse off as a result of this law.”

TABLE 1 – PPACA Premium Costs

The new health care reform will cover fewer medical procedures and each American will

have long waiting periods before they can get the medical care they seriously need. Under this
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plan if you need surgery or a transplant it may

take so long for the government to O.K. the

medical procedure that one might need, that

that person may die before the treatment is

approved. Other countries with this same

government run plan has put price tags on the

lives of their citizens. This health care plan

oversees your care and it makes the ill patients

wait for the critical care they need to survive.

When the reform starts to play a huge role in the medical field, it will not be a surprise

that the demand for medical services to increase with the health care reform proposal. Anyone

can buy insurance without limitations on pre-existing conditions. The people will likely utilize

more services because now they will have the insurance to go to the doctor more often. Even

though most disadvantaged people did have some access to health care even before reform, it's

different when you know you can walk in and be treated like a regular insured person. This

reform will increase the demand for medical services.

According to MSNBC (2011), “the House Republicans have voted to begin the work of

replacing President Barack Obama's landmark law that expands health insurance coverage.” The

huge wave of smaller-government response that crashed down on the Washington authorities has

been building for a long time, picking up steam with each passage of legislation that prolonged

the government’s violation into the lives of the American people. Central to all of this has been

the conflict surrounding health care reform. The bill creates within the federal government a

nationwide Health Insurance Exchange. It has been stated that the uninsured individuals would
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be free to purchase an Exchange plan, as would those whose existing employer coverage is

considered lacking by the federal government. Once considered eligible to enroll in the

Exchange, individuals would be allowed to remain in the Exchange until becoming Medicare


According to a letter addressed to, The Members of the U.S. House of Representatives,

written by R. Bruce Josten (2010); “The U.S. Chamber of Commerce, the world’s largest

business federation representing the interests of more than three million businesses and

organizations of every size, sector and region, strongly opposes the Senate-passed version of

H.R. 3590, the Patient Protection and Affordable Care Act. The bill is fundamentally flawed as

its underlying framework is the wrong approach to health reform.” According to the U.S.

Chamber of Commerce there are several problems with H.R. 3590 and they are as follows:

ƒ “Employer Mandate: The bill creates a damaging new mandate on employers that
would force them either to offer a government-mandated level of coverage or be liable
for significant new taxes;
ƒ New Taxes: The bill imposes nearly $500 billion in new taxes, many of which would fall
squarely on small businesses. Taxes on medical devices and prescriptions would be
passed through to consumers. Taxes on insurance plans would be passed on directly to
small businesses, as large self-insured employers are exempt;
ƒ Dangerous Entitlements and Medicare Cuts: The bill cuts approximately $500 billion
from Medicare. However, despite double-counting by the Congressional Budget Office
(CBO), this money will not be used to shore up the Medicare trust fund, which is
projected to be bankrupt by 2017. Rather, it will be used to create a vast new entitlement
that will transfer government funds to families making up to $88,000 a year;
ƒ Expensive Plan Requirements: Every health plan will be required to meet certain
standards set by the federal government, except for “grandfathered plans,” which the
President’s proposal essentially eliminates. The end result of these new requirements,
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according to CBO, is that health insurance on the individual market will be 10-13% more
expensive if H.R. 3590 is enacted, than if nothing is done;
ƒ Weak Cost Containment: The bill would do little to lower costs and for many would in
fact increase them, which is in part because numerous common-sense cost-containments
approaches are not included in the legislation.
o The bill contains only an inconsequential “sense of the Senate” nod to medical
liability reform, despite CBO’s finding that caps on punitive damages for doctors
could save $54 billion for the government and untold amounts for the private
o The bill does not allow all Americans to purchase health insurance across state
lines, which the CBO found would lower health care costs by 5%.
o The bill does not allow new small business pooling arrangements, which the CBO
found would not only increase coverage, but would also save money for the
federal government and the states by getting people off the Medicaid program and
into employer-sponsored plans.
o The bill would do nothing to curtail state benefit mandates that drive up the costs
of health insurance for small business.
o The bill would not make changes to successful high-deductible health plan
models to help them work better with innovative care concepts like patient-
centered medical homes.
o Lastly, the bill would not do enough to move away from fee-for-service and
toward outcome- and quality-based reimbursement for medical providers; and
ƒ Unworkable Small Business Tax Credits: Because of the extremely low wage
restrictions for small businesses to be eligible for credits, hardly any small businesses
would be eligible. Those businesses that are eligible would be required to offer highly
comprehensive plans and pay the vast majority of the employees’ premiums – and after
two or three years, the credit would vanish entirely, leading to an immediate spike in a
small businesses’ cost. These factors make it highly unlikely that most small businesses
would, or would be able to, take advantage of this credit.”
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The Chamber of Commerce stated that there are several problems with the bill, H.R. 3590

and those problems were stated very bluntly in the letter addressed to the U.S. House of

Representatives in March 2010. The bill was actually passed in March 2010, so this statement

tells me that even before the bill was passed, the problems were addressed to the senate but the

bill was still passed. As more than half of all high-income filers are small businesses, this bill

would cripple small businesses and destroy jobs during a deep recession. Many may be

concerned that this provision would lead to many companies dropping their current coverage as a

result. According to Curtis Dubay, in an article called, Obamacare and New Taxes: Destroying

Jobs and the Economy (2011), it discussed how, “ the Patient Protection and Affordable Care

Act (PPACA) imposes numerous tax hikes that transfer more than $500 billion over 10 years—

and more in the future—from hardworking American families and businesses to Congress for

spending on new entitlements and subsidies.” This bill contains 18 separate tax increases (listed

in Table 2), which in the long run will cost taxpayers $503 billion between 2010 and.2019.

According to, “two weeks after Republicans took control of the House in

January 2011; they kept a key campaign promise and voted to repeal President Barack Obama's

health-care law. The Democratic Senate later rejected the repeal, but House Republicans say they

still plan to "replace Obamacare with something that's a lot better. Their focus is to lower the

cost of care” (Lerer et al., 2011). When the Republicans went in keeping a promise to the people

and voted to repeal this bill, I feel as though they should have gone in with a better plan rather

than just going in with nothing to offer as a trade. In a recent article by Jason Millman (2011), it

was stated that the “republicans are also challenging how much authority Sebelius has to alter a

new long-term care insurance program, which she acknowledges is “totally unsustainable” in its
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current form. But Republicans are pointing to a new Congressional Research Service (CRS) that

questions just how much power Sebelius has to make changes to the voluntary program.

TABLE 2 – Obama Care Taxes (ref:

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The CRS report said a court may find the sweeping healthcare reform law does not provide the

HHS secretary with the authority to raise minimum earnings requirements in order to be eligible

for the program.” While the Secretary will be required to "negotiate" reimbursement rates with

doctors and hospitals, nothing in the law prohibits the Secretary from using such cooperation to

enforce Medicare reimbursement levels on providers as part of a government-imposed

"negotiation." The law requires the Secretary to "establish conditions of participation for health

care providers" under the government-run plan-however it includes no guidance or conditions

under which the Secretary must establish those conditions. Many may be concerned that the bill

would allow the Secretary to prohibit doctors from participating in other health plans as a

condition of participation in the government-run plan.

Both Virginia and Florida have challenged the act’s requirement that individuals must

carry health insurance as unconstitutional. Twenty-four other states have signed onto the lawsuit

as plaintiffs. According to Becker’s Hospital (2011), here are “13 legal issues

affecting hospitals and health systems in 2011”:

ƒ Lawsuits against the mandate to buy health insurance,

ƒ HIPAA and data breaches,

ƒ Antitrust issues and ACOs,

ƒ False claims and whistleblower suits,

ƒ Anti-Kickback and physician-hospital issues,

ƒ Impact of Stark Law on physician-hospital relationships,

ƒ Recovery audit contractors,

ƒ Compliance requirements for tax-exempt hospitals,

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ƒ Co-management arrangements,

ƒ Changes in reimbursement,

ƒ Labour and employment issues,

ƒ Mergers and antitrust law, and

ƒ Medical malpractice and tort reform.

The question of whether the Health Care Reform is constitutional is a hot topic in today’s

society. The answer to this question is different based on the individual who answers it and

which way their political views lean. Republicans would state no, while Democrats would most

likely argue yes. At the present time, the majority of individuals are stating that it is not

constitutional. The president and the Democratic congressional leadership are fighting frantically

to pass, with no Republican votes, the ever-less-popular health bill. On the short end of the vote,

Democrats challenged Republican claims and highlighted politically popular elements of the bill

that would be wiped out if repeal took effect. With all the arguing going on between Democrats

and the Republicans, the Republicans have been accused of hypocrisy by voting to repeal a vast

expansion of health care at the same time they had signed up for coverage for their families

through a government-organized program available [only] to lawmakers.

While the Republican-led House can pass legislation to repeal, the Senate, where the

Democrats presently hold a 53 to 47 advantage, is less likely to collect the votes to pass similar

legislation. Even if the a few embattled Senate Democrats were pulled over to the Republican

side, there would not be enough of the 66 votes required to overcome a Presidential veto. The

more realistic track will be the defunding effort that will take place as components of the Act are

brought up for implementation funding. The House can simply hold up funding by refusing
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appropriations or tying things up in committee hearings. While this is a slower process, it can

also cause a lot more pain by drawing out all of the Act’s defects holding them up to public

scrutiny, which never really occurred during its backdoor passage.

In the end, the

Affordable Health Care

Act may not be repealed

during this current session

of Congress, but it will be

starved, scrutinized and

assaulted in such a way

that it will remain as a

political ball and hammer

for pro-reform candidates in the next election. According to James Oliphant of the Los Angeles

Times, “the public’s attitude toward the law, however, has not shifted much at all. The

Affordable Care Act remains almost as equally loathed and celebrated as it was 12 months ago,

despite the best efforts of Democrats to praise it and Republicans to bury it. Even worse for both

sides, a majority of Americans remain confused about what the law actually accomplishes”.

Table 3 lists the major provisions/timetable of the Affordable Care Act and Table 4 summarizes

perceived pros and cons. If left standing, the law’s overall effect on business growth and

prosperity in this country is certainly controversial. But, most do agree that the result would be

monumental and historic, regardless of the net economic outcome.

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2010 NEW CONSUMER PROTECTIONS Putting Information for Consumers Online. Effective July 1, 2010.

Prohibiting Denying Coverage of Children Based on Pre- Effective for health plan years beginning on or
Existing Conditions. after September 23, 2010 for new plans and
existing group plans.

Prohibiting Insurance Companies from Rescinding Coverage. Effective for health plan years beginning on or
after September 23, 2010.
Eliminating Lifetime Limits on Insurance Coverage. Effective for health plan years beginning on or
after September 23, 2010.
Regulating Annual Limits on Insurance Coverage. Effective for health plan years beginning on or
after September 23, 2010.

Appealing Insurance Company Decisions. Effective for new plans beginning on or after
September 23, 2010.

Establishing Consumer Assistance Programs in the States. Grants Awarded October 2010.

IMPROVING QUALITY AND Providing Small Business Health Insurance Tax Credits. Effective now.

Offering Relief for 4 Million Seniors Who Hit the Medicare First checks mailed in June, 2010, and will
Prescription Drug “Donut Hole. continue monthly throughout 2010 as seniors
hit the coverage gap.

Providing Free Preventive Care. Effective for health plan years beginning on or
after September 23, 2010.
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Preventing Disease and Illness. Funding begins in 2010.

Cracking Down on Health Care Fraud. Many provisions effective now.

INCREASING ACCESS TO Providing Access to Insurance for Uninsured Americans with National program effective July 1, 2010.
AFFORDABLE CARE Pre-Existing Conditions.

Extending Coverage for Young Adults. Effective for health plan years beginning on or
after September 23.

Expanding Coverage for Early Retirees. Applications for employers to participate in

the program available June 1, 2010.

Rebuilding the Primary Care Workforce. Effective 2010.

Holding Insurance Companies Accountable for Unreasonable Grants awarded beginning in 2010.
Rate Hikes.

Allowing States to Cover More People on Medicaid. Effective April 1, 2010.

Increasing Payments for Rural Health Care Providers. Effective 2010.

Strengthening Community Health Centers. Effective 2010.

2011 IMPROVING QUALITY AND Offering Prescription Drug Discounts. Effective January 1, 2011.

Providing Free Preventive Care for Seniors. Effective January 1, 2011.

Improving Health Care Quality and Efficiency. Effective no later than January 1, 2011.
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Improving Care for Seniors After They Leave the Hospital. Effective January 1, 2011.

Introducing New Innovations to Bring Down Costs. Administrative funding becomes available
October 1, 2011.

INCREASING ACCESS TO Increasing Access to Services at Home and in the Community. Effective beginning October 1, 2011.

HOLDING INSURANCE COMPANIES Bringing Down Health Care Premiums. Effective January 1, 2011.

Addressing Overpayments to Big Insurance Companies and Effective January 1, 2011.

Strengthening Medicare Advantage.

2012 IMPROVING QUALITY AND Linking Payment to Quality Outcomes. Effective for payments for discharges
LOWERING COSTS occurring on or after October 1, 2012.

Encouraging Integrated Health Systems. Effective January 1, 2012.

Reducing Paperwork and Administrative Costs. First regulation effective October 1, 2012.

Understanding and Fighting Health Disparities. Effective March 2012.

INCREASING ACCESS TO Providing New, Voluntary Options for Long-Term Care The Secretary shall designate a benefit plan no
AFFORDABLE CARE Insurance. later than October 1, 2012.

2013 IMPROVING QUALITY AND Improving Preventive Health Coverage. Effective January 1, 2013.

Expanding Authority to Bundle Payments. Effective no later than January 1, 2013.

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INCREASING ACCESS TO Increasing Medicaid Payments for Primary Care Doctors. Effective January 1, 2013.
Providing Additional Funding for the Children’s Health Effective October 1, 2013.
Insurance Program.

2014 NEW CONSUMER PROTECTIONS Prohibiting Discrimination Due to Pre-Existing Conditions or Effective January 1, 2014.

Eliminating Annual Limits on Insurance Coverage. Effective January 1, 2014.

Ensuring Coverage for Individuals Participating in Clinical Effective January 1, 2014.

IMPROVING QUALITY AND Making Care More Affordable. Effective January 1, 2014.
Establishing Health Insurance Exchanges. Effective January 1, 2014.

Increasing the Small Business Tax Credit. Effective January 1, 2014.

INCREASING ACCESS TO Increasing Access to Medicaid. Effective January 1, 2014.


Promoting Individual Responsibility. Effective January 1, 2014.

Ensuring Free Choice. Effective January 1, 2014.

2015 IMPROVING QUALITY AND Paying Physicians Based on Value Not Volume. Effective January 1, 2015.
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PRO Health Care Reform Law CON Health Care Reform Law

1. Keeping Insurance Coverage

PRO: "No matter how we reform health care, we will keep this CON: "According to experts, more than 87 million American
promise: If you like your doctor, you will be able to keep your could lose access to their current health care plan under the
doctor. Period. If you like your health care plan, you will be new law. Workers at a majority of the nation’s employers –
able to keep your health care plan. Period. No one will take it including as many as four out of every five small businesses –
away. No matter what. My view is that health care reform would lose their current coverage, thus providing further
should be guided by a simple principle: fix what’s broken and evidence that ObamaCare is doing exactly the opposite of what
build on what works.” Democrats promised it would do."

Barack H. Obama, JD John Boehner

44th President of the United States Minority Leader of the United States House of Representatives (R-
Address to the annual meeting of the American Medical Association, OH)
June 15, 2009 "Obamacare, Three Months of Broken Promises,",
June 23, 2010

2. Quality of Care Improvements

PRO: "Patient care under Medicare will improve as pilot CON: "...[O]ur care will suffer. If the Democrats' plans
programs to improve efficiencies are implemented. Doctors become law, fewer than 700,000 physicians would be available
and hospitals are encouraged to coordinate care through to treat a patient population growing in size, aging in years,
payment incentives. For the first time, Medicare will reward shunning medical education and receiving 'free' health care or
quality, not quantity; thus, bonus payments will be given to insurance coverage from the government in increasing
those doctors and hospitals that provide good quality care." numbers.

Alliance for Retired Americans (ARA) The result will be longer wait times to see a doctor and a
"Medicare Benefits and Changes,", decline in the high quality of care Americans are accustomed to
Apr. 2010 as overworked physicians try to keep up."

Investor's Business Daily

"The Doctor Shortage,", Mar. 4, 2010

3. Private Health Insurance VS. Socialism

PRO: "Opponents of health insurance reform continue to CON: "Obama is a socialist. If you take over banks, if you take
spread myths, including peddling the bogus notion that the over car companies, if you take over financial institutions, the
health reform bill is 'socialism' and a 'government takeover of way that he has - now the health care system. If you're going to
health care.' The fact is the reform legislation builds on our use every crooked deal that you can come up with to get a bill
existing private health insurance system... like that passed - most recently the health care bill - that is by
definition, if you look up the dictionary definition of socialism,
[H]ealth insurance reform legislation expands private health this is it.”
insurance in America, and is based on increasing choice and
competition... among a variety of private insurance plans." Sean Hannity
Host of Fox News Channel’s Hannity show
Interview with, Mar. 25, 2010
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Nancy Pelosi
Speaker of the US House of Representatives (D-CA)
"Health Insurance Reform Mythbuster - 'Democrats' Health Insurance
Refrom Is Socialism and a Government Takeover,",
Mar. 19, 2010

4. Constitutionality
PRO: "The Constitution gives Congress the power to tax and CON: "Can Congress really require that every person
spend money for the general welfare. This tax [PPACA] purchase health insurance from a private company or face a
promotes the general welfare because it makes health care penalty? The answer lies in the commerce clause of the
more widely available and affordable. Under existing law, Constitution, which grants Congress the power 'to regulate
therefore, the tax is clearly constitutional... commerce... among the several states.'

Many important and popular government programs are based ...[T]he individual mandate extends the commerce clause's
[on] Congress's ability to give incentives through taxation and power beyond economic activity, to economic inactivity. That
redistribute tax revenues for public purposes. To strike down is unprecedented. While Congress has used its taxing power to
the individual mandate the Supreme Court would have to fund Social Security and Medicare, never before has it used its
undermine many years of precedents justifying these programs commerce power to mandate that an individual person engage
that stretch back to the New Deal (and in the case of the rules in an economic transaction with a private company. Regulating
for direct taxes, to the very founding of the country). the auto industry or paying 'cash for clunkers' is one thing;
making everyone buy a Chevy is quite another. Even during
Opponents of the individual mandate insist that they are only World War II, the federal government did not mandate that
defending individual freedom, but they are actually taking a far individual citizens purchase war bonds."
more radical position. They are really claiming that it is
unconstitutional to make Americans pay taxes." Randy E. Barnett, JD
Carmack Waterhouse Professor of Legal Theory at the Georgetown
University Law Center
Jack M. Balkin, JD, PhD
"Is Health-Care Reform Constitutional?," Washington Post,
Knight Professor of Constitutional Law and the First Amendment at
Mar. 21, 2010
Yale Law School
"Is the Health Care Law Unconstitutional?," New York Times,
Mar. 28, 2010

5. Insurance Premium Reductions

PRO: "We estimate that, on net, the combination of CON: "Throughout the year-long debate over health care
provisions in the new law will... lower premiums by nearly reform, President Obama promised that the legislation would
$2,000 per family... reduce the spiraling cost of health care... But a couple of new
government reports confirm what many of us who opposed a
Without reform, premiums are expected to increase from federal takeover of the health care system feared all along -
$13,305 in 2010 to $21,458 in 2019. Relative to this increase, higher costs...
premiums under reform increase only threequarters as much.
By 2019, family premiums are nearly $2,000 lower. Adding CMS [Centers for Medicare and Medicaid Services] says that
reductions in out-of-pocket costs and lower taxes for Medicare the health care law will impose billions of dollars in annual
and Medicaid will result in estimated savings for the typical fees on manufacturers and importers of brand-name
family of over $2,500 that year." prescription drugs and on health insurance plans, and new taxes
on medical device sales. CMS said it anticipates that these new
Center for American Progress (CAP) fees and taxes will be passed down to consumers in the form of
"The Impact of Health Reform on Health System Spending," higher drug and device prices and higher insurance premiums,, May 2010 raising health care costs from $2.1 billion in 2011 to $18.2
billion in 2018. Throughout the health care debate, Americans
were told the Democrats' health care reform measure would
Affordable Care Act Page 21 of 25

make premiums more affordable; instead, as the President's

own actuary at CMS confirms, Americans will face higher

Lisa Murkowski, JD
US Senator (R-AK),
New Health Care Law Will Increase Costs, Reduce Benefits,", May 18, 2010

6. Medical Bankruptcy Prevention

PRO: "The Senate plan limits how much even the wealthiest CON: "Most people with medical bankruptcies already have
family buying insurance in the Exchange can be expected to insurance, and out-of-pocket expenses will continue to be a
pay, out-of-pocket, in a given year to a total of $11,900 for a burden on the middle class.
family, and $5,950 for an individual. Again, lower-income
households are expected to pay less… • In 2009, 1.5 million Americans declared bankruptcy
• Of those, 62% were medically related
These caps should virtually eliminate medical bankruptcy. The • Three-quarters of those had health insurance
total amount that a family can possibly owe is low enough that • The Obama bill leaves 24 million without insurance
providers will be willing to give them time to pay it off, and in • The maximum yearly out-of-pocket limit for a family
many cases, to negotiate discounts. will be $11,900 on top of premiums
• A family with serious medical problems that last for a
When providers know that there is no way that you can ever few years could easily be financially crushed by
pay a $50,000 bill, you wind up in bankruptcy court. When the medical cost
amounts are smaller, and doable over time, negotiations are
possible." Real health care reform is needed. But this bill falls short of
that on many levels."
Maggie Mahar, PhD
Fellow at the Century Foundation
Jane Hamsher, MFA
Response to Paul Starr's article "What Is in the Health Care Bill,"
Founder and Publisher of Firedoglake, Dec. 17, 2009
"Fact Sheet: The Truth About the Health Care Bill,", Mar. 19, 2010

7. Federal Deficit Reduction

PRO: "CBO [Congressional Budget Office] and JCT [Joint CON: "In reality, if you strip out all the gimmicks and
Committee on Taxation] estimate that enacting both pieces of budgetary games and rework the calculus, a wholly different
legislation—H.R. 3590 and the reconciliation proposal—would picture emerges: The health care reform legislation would
produce a net reduction in federal deficits of $143 billion over raise, not lower, federal deficits, by $562 billion..."
the 2010–2019 period as result of changes in direct spending
and revenues. That figure comprises $124 billion in net Douglas Holtz-Eakin, PhD
reductions deriving from the health care and revenue President of the American Action Forum and former Director of the
provisions and $19 billion in net reductions deriving from the Congressional Budget Office
education provisions." "The Real Arithmetic of Health Care Reform," New York Times,
Mar. 20, 2010
Congressional Budget Office (CBO)
Report (untitled) on the estimated budgetary effects of the March 2010
health care reform laws,, Mar. 20, 2010
Affordable Care Act Page 22 of 25

8. Tax Reductions
PRO: "The health reform legislation signed into law by CON: "The Senate bill would: impose job-killing mandates
President Obama includes the largest health care tax cut in and penalties on businesses, [and] increase taxes and burdens
history for middle class families, helping to make insurance on small businesses... H.R. 4872 is no 'fix' for the Senate-
much more affordable for millions of families... passed bill. It includes a long term hidden tax by deferring the
'Cadillac tax' on certain high cost health plans until 2018. The
The Small Business Health Care Tax Credit can cover up to 35 number of Americans that will ultimately suffer from this
percent of the premiums a small business pays to cover its hidden tax will mushroom each year because the tax is indexed
workers. In 2014, the rate will increase to 50 percent..." to inflation...

Dan Pfeiffer This bill would also impose a new 3.8 percent 'Medicare tax'
White House Communications Director on non-wage income that would target high income earners,
"Health Reform and the Recovery Act: Unprecedented Tax Cuts for income from interest, dividends, capital gains, and some profits
the Middle Class,", Apr. 13, 2010 from investments in partnerships and S-corporations. If this tax
and other tax increases included in the President's FY 2011
budget become law, certain taxpayers could expect a marginal
tax rate on capital gains and qualified dividends of 23.8
percent, and a marginal tax rate on nonqualified dividends of
43.4 percent."

US Chamber of Commerce
"H.R. 3590, the 'Patient Protection and Affordable Care Act,' and the
Related Budget Reconciliation Legislation, H.R. 4872, the 'Student
Aid and Fiscal Responsibility Act of 2009,'", Mar. 19, 2010

9. Fixing the Physician Shortage

PRO: "The recently enacted PPACA (H.R. 3590) includes CON: "Questions have been raised as to whether there will be
numerous policies to train more primary care physicians and a sufficient supply of physicians and other health professionals
increase the supply of primary care physicians. These policies to serve the nation, especially in light of concerns that the
include: mandatory and increased discretionary funding for the nation was facing potentially significant shortages even before
National Health Service Corp (NHSC), reauthorization of health care reform...
Section 747 of Title VII, Training in Family Medicine, General
Internal Medicine, General Pediatrics, and Physician [W]e project an overall shortage of 91,500 and 130,600 active
Assistantship; creation of a Primary Care Training Extension patient care physicians in 2020 and 2025 respectively, and a
Program and increased faculty scholarship loans, redistribution primary care shortage of 45,400 and 65,800 physicians in 2020
of 65% of the current unused Graduate Medical Education slots and 2025...
to primary care and general surgery and allowing residents to
count their time spent in ambulatory settings to count towards
These revised estimates are consistent with earlier estimates:
their residency requirements, such as physician offices and they indicate the health care system is likely to be facing severe
community health centers; and the establishment of Teaching pressure as demand rises more rapidly than the supply."
Health Centers, creating primary care residency programs in
non-hospital settings."
Association of American Medical Colleges (AAMC)
"The Impact of Health Care Reform on the Future Supply and
American College of Physicians (ACP) Demand for Physicians Updated Projections Through 2025,"
"Ensuring an Adequate Supply of Primary Care Internists and Other, June 2010
Specialties Facing Shortages,",
Apr. 7, 2010
Affordable Care Act Page 23 of 25

10. Medical Malpractice Lawsuits

PRO: "As part of a 'grand bargain' to create a bipartisan health CON: "You would think that any effort to reform our health
care bill, some have said tort reform should be included... care system would include tort reform, especially if the stated
purpose for Obama’s plan to nationalize our health care
Look at what the actual data says: 98,000 people dead every industry is the current high costs...
year from preventable medical errors, at a cost of $29 billion.
Countless more are seriously injured with astronomical costs. Many states, including my own state of Alaska, have enacted
The Congressional Budget Office and Government caps on lawsuit awards against health care providers. Texas
Accountability Office have looked at tort reform multiple enacted caps and found that one county’s medical malpractice
times, and said it will save practically no money. They also claims dropped 41 percent, and another study found a '55
found no evidence of so-called 'defensive medicine,' finding percent decline' after reform measures were passed.
that doctors run more tests because of the fee-for-service
structure, or because of the benefits extra tests have on patient Texas Gov. Rick Perry noted that, after his state enacted tort
care. reform measures, the number of doctors applying to practice
medicine in Texas 'skyrocketed by 57 percent' and that the tort
Additionally, a 2006 study from Harvard found that 97% of reforms 'brought critical specialties to underserved areas.'
cases were meritorious, totally debunking the idea that These are real reforms that actually improve access to health
frivolous lawsuits plague our courts. And while 46 states have care.
enacted some kind of tort reform, health care costs have
continued to skyrocket, while injured patients or their families ...[R]esearch shows that around $200 billion per year could be
often can't seek justice... saved with legal reform. That’s real savings.

Forty-six states have tort reform, and American families still If you want to save health care, let’s listen to our doctors.
shoulder exorbitant health care costs. All the facts and data say There should be no health care reform without legal reform.
it doesn't work. There's still 98,000 people dead every year There can be no true health care reform without legal reform."
from medical errors. But when political gamesmanship and
backroom deals take over, the facts fly out the window. Sarah Palin
Former Governor of Alaska
This health care bill has a long way to go. But let's be perfectly "No Health Care Reform Without Legal Reform,"
clear: patients' rights aren't negotiable. Tort law changes won't, Aug. 21, 2009
fix health care, but only make it more difficult for injured
patients to seek justice. Instead of bargaining away patients'
rights, Congress should [put] their safety first."

Anthony Tarricone, JD
Former President of the American Association of Justice
"Tort Reform: A Bad Bargain That Won't Fix Health Care,", Sep. 22, 2009
Affordable Care Act Page 24 of 25


Dubay, C. (20, January 2011). Obamacare and new taxes: Destroying jobs and the economy.

WebMemo. The Heritage Foundation. Retrieved on April 18, 2011, from

Josten, R. B. (12, March 2010). Chamber of Commerce of the United States of America.

Executive Vice President Government Affairs. Retrieved on March 29, 2011 from


Lerer, L. and Armstrong, D. (24, March 2011). The republican response to Obamacare

politics & policy. Retrieved on March 29, 2011 from

Millman, J. (28, March 2011). GOP questions HHS authority to grant healthcare waivers. The Retrieved on March 30, 2011 from



MSNBC. (20, Jan. 2011). GOP's health care repeal: Now for the hard part. House Republicans

won a symbolic victory, but now face a wall of opposition in the Senate.

Retrieved on March 29, 2011 from


Oliphant, J. (23, March 2011). Healthcare laws condition is anything but stable on its

anniversary. Los Angeles Times. Retrieved on March 24, 2011 from,0,293235.story
Affordable Care Act Page 25 of 25


Page, L. and Fields, R. (14, March 2011). 13 Legal Issues for Hospitals and Health Systems.

Becker Hospital Retrieved on March 28, 2011 from

issues-for-hospitals-and-health-systems.htm (2010, September 1). Top 10 Pros & Cons.

Retrieved on April 17, 2011 from

Rugy, V. (4, November 2010). Does ObamaCare reduce health care spending? The short answer

is no. Retrieved on April 17, 2011 from

Tanner, M. (2011). Bad Medicine: A guide to the real costs and consequences of the new health

care law. Cato Institute. Retrieved on April 17, 2011 from