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Top 10 Pro & Con Arguments
Is the Patient Protection and Affordable Care Act (Obamacare) Good for America?






1. Cost of Health Insurance

"[M]ost people will pay more for health insurance next year. That's true whether you get coverage from a job, on your own through an exchange or directly from an insurer, or from Medicare...

The good news is that available information indicates the doomsayers were wrong, and premiums under President Barack Obama's health care law aren't going through the roof.

The average increase for Obamacare plans will be 8.2 percent next year in 29 states and the District of Columbia where data about health insurance premiums for 2015 are available... That's significant, but it's a little lower than the 10 percent annual rate hikes typical before the Affordable Care Act."

Jeffrey Young
Huffington Post health care reporter,
"Here's What's Going on with Obamacare Premium Increases,"
huffingtonpost.com,
Aug. 21, 2014


"[T]here can be no doubt that health care today is more costly than it would have been without Obamacare...

Measured over two years, Obamacare's rate hikes remain toxic. And further increases are on the horizon in 2017, when some of the law's subsidies to insurance companies are set to expire...

I and my colleagues at the Manhattan Institute looked at the actual, finalized rate filings in 2014 and compared them to what was available in 2013. The average U.S. county saw a rate increase of 49 percent."

Avik Roy, MD
Forbes' Opinion Editor and Senior Fellow at the Manhattan Institute for Policy Research,
"Obamacare Has Failed to Collapse -- but Its Premiums Continue to Climb," forbes.com,
Sep. 14, 2014


 
2. Impact on Federal Deficit

"In keeping with the President's pledge that reform must fix our health care system without adding to the deficit, the Affordable Care Act reduces the deficit, saving over $200 billion over 10 years and more than $1 trillion in the second decade. The law reduces health care costs by rewarding doctors, hospitals and other providers that deliver high quality care and making investments to fund research into what works.

Rising health care costs are a major driver of our long-term deficits, and getting them under control is crucial if we want to grow the economy, create jobs and compete in the world economy."

White House
"Deficit-Reducing Health Care Reform," whitehouse.gov,
(accessed May 20, 2015)


"[T]he Democrats' health care law [Obamacare] will increase the budget deficit by $131 billion over the current 10-year budget window (FY 2015–2024). This estimate is arrived at by taking the $180 billion in projected deficit reduction from the CBO 2012 extrapolation and then accounting for the lower net cost of the coverage provisions ($83 billion), the lower estimated federal health care savings under the plan ($132 billion), as well as the lower projected revenue levels when including the labor market effects of the legislation ($262 billion). The difference between the 2012 extrapolation and the current estimate of the cost of the Democrats' health law amounts to a $311 billion change in its net deficit impact."

US Senate Committee on the Budget Republicans
"Analysis of CBO Data Shows That Obamacare Will Increase Deficit over Next Decade,"
budget.senate.gov,
Oct. 14, 2014


 
3. Improved Medicare?

"The Affordable Care Act includes a series of Medicare reforms that will generate billions of dollars in savings for Medicare and strengthen the care Medicare beneficiaries receive. The new law protects guaranteed benefits for all Medicare beneficiaries, and provides new benefits and services to seniors on Medicare that will help keep seniors healthy. The law also includes provisions that will improve the quality of care, develop and promote new models of care delivery, appropriately price services, modernize our health system, and fight waste, fraud, and abuse."

Centers for Medicare & Medicaid Services
"Affordable Care Act Update: Implementing Medicare Cost Savings,"
www.cms.gov,
(accessed on June 17, 2015)


"To partially offset the ACA's new spending, the law contains spending cuts to Medicare that amount to $716 billion from 2013 to 2022. The Medicare Trustees have warned since the law's passage that if these cuts are implemented as the law requires, they will significantly impact seniors' access to and quality of care. For example, the law reduces payments in the Medicare Advantage (MA) program, the private insurance option under Medicare, by $156 billion from 2013 to 2022. These cuts are already causing MA plans to adjust their benefit packages by restricting provider networks. The end result of course is that seniors have fewer provider options and in some cases are forced to find new doctors."

Alyene Senger
Research Associate in the Center for Health Policy Studies at the Heritage Foundation,
"Eight Groups Harmed by the ACA's Flawed Policies,"
heritage.org,
Feb. 23, 2015


 
4. Improved Medicaid?

"Beyond expanding Medicaid, the ACA introduced other reforms that improve the program in all states, regardless of their Medicaid expansion decision. The law required states to simplify and modernize their enrollment processes, and to create a coordinated eligibility and enrollment system for Medicaid, the Children's Health Insurance Program (CHIP), and the Marketplace, to facilitate enrollment and promote continuity of coverage.

The ACA also established an array of new authorities and funding opportunities for delivery system and payment reform initiatives in Medicare, Medicaid, and CHIP, designed to advance better and more cost-effective models of care, particularly for those with high needs and costs, whose care is poorly coordinated, leading to both serious gaps and costly redundancy.

Finally, the law provided new options and incentives to help states rebalance their Medicaid long-term care programs in favor of community-based services and supports rather than institutional care. Collectively, these provisions have accelerated Medicaid innovation already underway in many states."

Julia Paradise, MS
Associate Director of the Kaiser Commission on Medicaid, "Medicaid Moving Forward,"
kff.org,
Mar. 9, 2015


"According to a recent study, perhaps up to 80% of ObamaCare's new Medicaid enrollees previously had private insurance plans...

One recent study found that Medicaid is not only worse than private insurance — it can be worse than having no insurance at all. Medicaid patients were 25% likelier to have an in-hospital death than those completely without health insurance.

The same study also found that, compared with private insurance, Medicaid patients were twice as likely to have an in-hospital death, had the longest lengths of hospital stays and had the highest costs...

These are startling results for a government-run health care system advertised as a quality substitute for private insurance. In reality, ObamaCare has created a two-tier health care system — and it's forcing millions of patients out of the top tier and into the bottom."

Jeffrey A. Singer, MD
practicing surgeon and Adjunct Scholar at the CATO Institute,
"Obamacare's Medicaid Expansion Limits Medical Choices," cato.org,
Oct. 30, 2014


 
5. Primary Care Physician Shortage

"Our analysis indicates that the ACA is expected to result in roughly 20.3 million additional primary care visits nationally, with people newly insured through the marketplaces accounting for more than a third of these visits, or about 3.8 percent above base...

The U.S. health system is likely to be able to absorb these increases… anticipated increases in doctor's visits by the newly insured can be accommodated through organizational changes and changes in practice patterns...

It is critical that the expansion of health insurance coverage leads to improved access to care for those who were previously uninsured and does not limit access for those who already have coverage. Our results suggest that the current supply of primary care physicians and physicians in most specialties is sufficient to ensure this result will hold."

The Commonwealth Fund
"How Will the Affordable Care Act Affect the Use of Health Care Services?,"
commonwealthfund.org,
Feb. 2015


"Projected shortfalls in primary care will range between 12,500 and 31,100 physicians by 2025…

Expanded medical coverage achieved under ACA once fully implemented will likely increase demand by about 16,000 to 17,000 physicians (2.0%) over the increased demand resulting from changing demographics.

The Congressional Budget Office estimates that 26 million people who otherwise would be uninsured in the absence of ACA eventually will have medical insurance. Taking into consideration the health and risk factors of the population likely to gain insurance and estimated changes in care utilization patterns associated with gaining medical insurance, the projected increase in demand for physician services is about 2.0%. The increase is highest (in percentage terms) for surgical specialties (3.2%), followed by primary care (2.0%), medical specialties (1.7%), and 'all other' specialties (1.5%)."

The Association of American Medical Colleges
"The Complexities of Physician Supply and Demand: Projections from 2013 to 2025,"
aamc.org,
Mar. 2015


 
6. Independent Payment Advisory Board (IPAB)

"The point of having such a board — and here I can perhaps speak with some authority, as I was present at the creation — is to create a process for tweaking our evolving payment system in response to incoming data and experience, a process that is more facile and dynamic than turning to Congress for legislation...

With that in mind, consider the recent attack on the Independent Payment Advisory Board in the Wall Street Journal by Howard Dean, the former chairman of the Democratic National Committee. His critique begins by claiming that the board 'is essentially a health-care rationing body,' even though the legislation specifically states that the board is not allowed to make any recommendations that would ration care."

Peter R. Orszag, PhD,
Chairman of the Financial Strategy & Solutions Group at Citigroup, and former Director of the US Office of Management and Budget,
"The Critics Are Wrong about IPAB,"
thehealthcareblog.com,
July 31, 2013


"Perhaps one of the most troubling parts of Obamacare is the Independent Payment Advisory Board (IPAB). The IPAB will consist of fifteen unelected bureaucrats who are granted substantial powers to reduce Medicare spending. IPAB's proposals could, for example, cut reimbursement for specific services that it determines not to be of high value…

Supporters of the board like to claim that IPAB is prevented from rationing care, and as far as the language of the law reads, that's true. But dig a little deeper and you find out what's prevented depends on how you define the word 'rationing.' The IPAB is not allowed to say that a person should be denied a particular treatment or type of care, but the IPAB is allowed to cut payments to the physicians that perform these treatments low enough that the effect is no physician is willing to provide the treatment. In my view, the board is rationing care if the effect of their decisions is reduced access to needed care."

Phil Roe, MD
US Representative (R-TN),
"Challenging the IPAB,"
roe.house.gov,
Dec. 3, 2014


 
7. Abortion Funding

"Since 1977, federal law has banned the use of any federal funds for abortion, unless the pregnancy is a result of rape, incest, or if it is determined to endanger the woman's life. This rule, also known as the Hyde Amendment, is not a permanent law; rather it has been attached annually to Congressional appropriations bills, and has been approved every year by the Congress...

The ACA reinforces the current Hyde Amendment restrictions, continuing to limit federal funds to pay for pregnancy terminations that endanger the life of the woman or that are a result of rape or incest... State Medicaid programs continue to have the option to cover abortions in other circumstances using only state funds and no federal funds. President Obama issued an executive order as part of health reform that restated the federal limits specifically for Medicaid coverage of abortion."

Henry J. Kaiser Family Foundation
"Coverage for Abortion Services and the ACA,"
kff.org
Sep. 19, 2014


"[T]he President's health care law authorized massive subsidies to assist millions of Americans to purchase private health plans that cover abortion on demand...

While the Hyde Amendment prohibits federal funds to any health plan that includes abortion except for rape, incest or to save the life of the mother, the Secretary of the Treasury pursuant to notice by the Secretary of Health and Human Services, is today making monthly advance payments with U.S. taxpayer funds to insurance companies or to exchanges to pay for health insurance plans that subsidize abortion on demand.

It couldn't be more clear—the President is not extending the Hyde Amendment to the 'newly created exchanges'."

Chris Smith,
US Representative (R-NJ),
"Does Obamacare Provide Federal Subsidies for Elective Abortions?,”
Washington Post,
Jan. 26, 2015


 
8. Emergency Room Impact

"Though people will continue to require emergency care, this decision [Supreme Court upholding Obamacare] means that millions of people will have access to basic, primary health care and preventive services which should ultimately reduce the numbers of patients seeking routine care in the emergency department. Patients will get the care they need earlier instead of becoming seriously ill and requiring complex, acute care in a hospital emergency department."

The Emergency Nurses Association (ENA)
"ENA Applauds Supreme Court Decision,"
www.ena.org,
June 28, 2012



"Since the implementation of the ACA, the majority of member physicians have noticed an increase in the volume of emergency patients. Specifically, 47% of emergency physicians indicate slight increases in the number of patients, while 28% of respondents report significant increases in the number of emergency patients."

The American College of Emergency Physicians (ACEP)
"2015 ACEP Poll Affordable Care Act Research Results,"
newsroom.acep.org,
Mar. 2015


 
9. Physicians Views

"This week, we celebrate five years of progress since the Patient Protection and Affordable Care Act, known as Obamacare or the ACA, was signed into law.

Beyond the headlines and politics, the law is changing America. Every day, we are moving closer to a country where we choose to take care of those who are sick no matter who they are...

Today, 16.4 million more people have health insurance. Hospitals and patients working together have prevented 150,000 readmissions to hospitals. Individuals and taxpayers have saved billions of dollars."

Alice Chen, MD
practicing internal medicine hospitalist, and the Executive Director of Doctors for America,
"5 Years of Progress: Time for Patients Over Politics,"
huffingtonpost.com,
Mar. 25, 2015


"Obamacare seeks to lower the cost of health care, but instead it creates new arrangements that will only make medical care more expensive...

I don't consider it successful if the only way we reduce the roles of the uninsured in this country is by obligating more Americans to a Medicaid program that is quite literally worsening medical outcomes...

Obamacare makes so many costly promises on paper, but the only way to pay for these commitments is to reduce what providers are paid. And Obamacare, this is now a network that contains a very short list of providers and closed drug formularies that leave key medicines uncovered… Obamacare was a response to a flawed healthcare system. There's no question about that. But it makes things worse."

Scott Gottlieb, MD
practicing physician and Resident Fellow at the American Enterprise Institute,"
Obamacare Is Now Beyond Rescue,"
intelligencesquaredus.org,
Jan. 15, 2014


 
10. Impact on Business

"The Patient Protection and Affordable Care Act -- otherwise known as Obamacare -- is putting such a small dent in the profits of U.S. companies that many refer to its impact as 'not material' or 'not significant,'...

That's even after a provision went into effect this year requiring companies with 50 or more full-time workers to provide coverage, and after more workers are choosing to enroll in existing company coverage because of another requirement that all Americans get insured...

The collective shrug from the nation's biggest employers undermines the arguments of Republicans, who call the law a job-killer as they seek its repeal.

While U.S. health-care costs continued to rise faster than inflation in the five years since the law was passed, their rate of growth has slowed. Employers spent an average of $11,204 per worker for health benefits in 2014, up 4.6 percent from a year earlier, according to Mercer LLC. That growth rate was 6.1 percent or more each year from 1998 to 2011."

Bloomberg
"Obamacare Is Barely Denting Corporate Profits,"
Bloomberg.com,
Feb. 18, 2015


"Let's make this clear: The law has not produced lower costs...

Obamacare's administrative and compliance burdens are not insignificant either. They are imposing hefty costs on top of general frustration for small businesses…

Moreover, the complexity of Obamacare's employer mandate (where, for example, a 30-hour work week is considered full time) and its sheer costs have forced small businesses to cut hours, wages and jobs...

From the small business perspective, Obamacare has exacerbated their 20-plus year struggle with health insurance – costs are too high and keep increasing, innovative choices are lacking, and buying coverage and administering health insurance is a burdensome hassle."

Small Business & Entrepreneurship Council (SBE Council)
"Small Businesses and the Affordable Care Act at Five Years,"
sbecouncil.org,
Mar. 23, 2015