Nullification ... and the Cost of ObamaCare | Eastern North Carolina Now

    Mike Sacks, "Supreme Court Healthcare Decision: The Individual Mandate Survives," Huffington Post, June 28, 2012. Referenced at: huffingtonpost.com

    Rep. Phil Hare (D-Ill) comments to reporter - reason.com

    "A History Lesson on Government-Run Programs," Soda Head - sodahead.com

    Comments by Democratic Congressmen on the Constitution - commonsensewonder.blogspot.com

    Thomas Jefferson's Reactions - streetlaw.org

    Angie Drobnic Holan, "Smokers, Tanning Aficionados, the Happily Uninsured: More Taxes Coming at Ya!," PolitifFact.com, April 8, 2010. Referenced at: politifact.com

    Paul Jacob, "The Supreme Oxymorons," Townhall, July 1, 2012. Referenced at: townhall.com

    The 17th Amendment repealed Article I, Section 3 which provided that Senators would be appointed by the state legislatures and provided that they would be elected by the people.

    A 2011 census shows that 15% of Americans, on average, are living in poverty. [28% of blacks are living in poverty, whites are in single digits, and Hispanics and Asians are tied somewhere in the middle]

    Terence P. Jeffrey, "Gallop: 72% of All Americans and 56% of Democrats Say Obamacare Mandate is Unconstitutional," CNS News, February 27, 2012. Referenced at: cnsnews.com

    William J. Watkins, "The Kentucky and Virginia Resolutions" - constitution.org

    The Virginia Resolves of 1798 - lexrex.com

    The Kentucky Resolves of 1798 and 1799 - lexrex.com

    APPENDIX:

    I. 50 DANGERS of OBAMACARE (broken down by category):

    1). For those concerned with the damage this plan will do to business:

    Pg 22 mandates that the Government will audit books of ALL EMPLOYERS that self insure. So every employer in the United States will be subjected to a health insurance audit just as all taxpayers are subject to audit. Of course, we will have to pay for an entire new bureaucracy to do this-the Internal Health Revenue Service?
    Pg 42 recognizes the power of the Health Choices Commissioner to determine your health benefits. You will have no choice.
    PG 50, section 152 states that free, taxpayer-paid health care will be given to the 30 million non-citizens in the USA, even illegal aliens.
    Pg 30, Sec 123 states that there will be a government committee that decides what treatments you are allowed and what your overall benefits are.
    Pg 29, lines 4-16 basically mandates the rationing of health care as is being done in Canada.
    Pg 42 recognizes the power of the Health Choices Commissioner to determine your health benefits. You will have no choice.
    Pg 58 states that government will have possession of all your health care records & history including finances and you will have to have a National ID Healthcard.
    Pg 59, lines 21-24 gives direct access to your banks accounts to compel you to pay any out-of-pocket or premium costs electronically without your previous consent.
    Pg 72, lines 8-14 creates a Health Care Exchange to bring private health insurance plans under government control. This part of the bill reveals Obama's lies about being able to keep your plan if you like it. Any health insurance plan which does not completely rework itself to conform to these regulations will be dropped from the exchange and those insured will have to pick one of the plans in the exchange. This is why the Congressional Budget Office determined that over 20 million will lose the coverage they are now enjoying if Obamacare is implemented.
    Pg 145, line 15-17 any employer not currently insuring their employees must enroll employees into public plan option, with no choice of private insurance allowed.
    Pg 126, lines 22-25 mandates that employers must pay for health insurance even for part-time workers and their families, which will certainly lead to massive layoffs.
    Pg 149, lines 16-24 all employers with an annual payroll bigger than $400k who does not pay to enroll employees in public insurance option will pay an 8% tax on all payroll.
    Pg 167, lines 18-23 any individual who is self-employed and does not have health insurance will be taxed 2.5% of income and forced to accept public health insurance. So paying for health care out of pocket will be banned from the face of the earth.
    For those concerned with the inherent unfairness in this plan.
    Pg 65, sec 164 provides for a political payoff from the Democrats and Obama; a special subsidized plan for retirees and their families in unions community groups like ACORN.
    Pg 102, lines 12-18 mandates that all Medicaid eligible will be automatically enrolled in Medicaid based upon income and insurance status. No choice.
    Pg 124, lines 24-25 states that no private company or individual can have the right to sue the federal government for medical price fixing, basically eliminating your right to seek redress in the courts regarding your medical care.
    Pg 469 mandates "Community Based Home Medical Services" through non profits like ACORN. Happy yet that we elected a community organizer to the White House?

    2). For those afraid of healthcare rationing:

    Pg 85, line 7 provides specifics for benefit levels for all health plans, giving government the right to ration everyone's healthcare.
    Pg 239, line 14-24 mandates that available physician services will be reduced for Medicaid recipients. Many poor people including many seniors will be affected.
    Pg 272, Sec. 1145 regulates the operation of certain types of cancer hospitals, again rationing the care of cancer patients.

    3). For those concerned with the costs of this plan:

    PG 91, lines 4-7 mandates that doctor's offices, clinics and hospitals provide language-appropriate services, basically ordering them to hire translators at the expense of the American taxpayer.
    Pg 95, lines 8-18 allows the government to hire non-profit community groups like ACORN and Americorps to sign up people for the government health plan.
    Pg 170, lines 1-3 exempts non-resident aliens from the individual health care taxes, so Americans citizens will pay for these aliens, legal and illegal alike.
    Pg 489, Sec 1308 force taxpayers to pay for Marriage & Family therapy under the public insurance plan.

    4). For those concerned with the damage this plan will do to the medical profession:

    Pg 127, lines 1-16 dictates doctors' payment and therefore income which will reduce what doctors earn and lead to greater shortages of doctors and more rationing of care.
    Pg 150, lines 9-13 mandates that employers with an annual payroll between $251K & $400K who does not pay to enroll employees in public insurance option will pay a 2-6% tax on all payroll.
    Pg 241, line 6-8 mandates that all doctors receive the same pay, regardless of specialty. This will vastly reduce the number of specialists available in the United States, a common problem where medicine is socialized like Canada.
    Pg 253, line 10-18 allows the federal government to set the value of doctor's time, professional judgment.
    Pg 265, Sec 1131 mandates and controls the productivity of all health care providers including surgeons!
    Pg 280, Sec 1151 allows the government to penalize hospitals for what is deemed to be preventable readmissions. So instead of being sued for malpractice, the government will be the punitive body when mistakes are made.
    Pg 298, lines 9-11 mandates that if a doctor treats a patient during initial admission and that result in a re-admission, the doctor will be subject to federal penalties. Gee do you think that's going to drive up the cost of malpractice?
    Pg 317, lines 13-20 will create prohibitions on ownership and investment in the health service industry for doctors.
    Pg 317-318, lines 21-25, and 1-3 will prohibit the expansion of all hospitals.
    pg 321, lines 2-13 allows hospitals apply for an exception to the expansion rule but they must seek community input first!
    Pg335, lines 16-25, Pg 336-339 mandates the establishment of outcome based health care and insidious idea that actually limits the treatment choices made by patients with their doctors, based upon the patient's health and condition. This will result in the oldest, weakest and sickest patients being denied treatments simply because the statistics for success in their demographic category are poor! This is a form of health care rationing that will save money at the expense of seniors to help buy insurance for the uninsured, most of whom are young and healthy!
    Pg 341, lines 3-9 allows the government to disqualify Medicare Advantage Plans and HMO forcing people into the government run public plan.

    5). For those concerned with violations of individual rights violations in this plan:

    Pg 195 officers & employees of the new Health Care Administration will have access to all Americans personal financial records and accounts.
    Pg 203, line 14-15 actually says that "The tax imposed under this section shall not be treated as tax." Yes, it says that.
    Pg 268, Sec 1141 regulates the rental & purchase of power driven wheelchairs.
    Pg 379, Sec 1191 mandates the creation of even more bureaucracy in the Telehealth Advisory Committee.
    Pg 425, lines 4-12 mandates "Advance Care Planning Consultation," another insidious vehicle to save money by encouraging seniors who are in poor health to be more accepting of death rather than fighting to stay alive and healthy and with their loved ones.
    Pg 425, lines 17-19 mandates that all senior patients will be consulted regarding living wills, durable powers of attorney.
    Pg 425, lines 22-25, 426 lines 1-3 provides an approved list of end of life resources, to help guide seniors about the process of dying!
    Pg 427, lines 15 mandates program for orders on the end of life, actually giving the government a say in how your life ends!
    Pg 429, lines 1-9 dictates the frequency with which an Advance Care Planning Consultant will have to meet with patients as their health deteriorates.
    Pg 429, lines 10-12 give an Advance Care Planning Consultant the power to order end of life plans for a patient.
    Pg 354, Sec 1177 will arbitrarily restrict the enrollment of special needs children and adults.
    Pg 429, lines 13-25 will only allow certain doctors, not necessarily your own physician, to write an end of life order.
    Pg 430, lines 11-15 allows the government to decide what level of treatment you will have at end of life.
    Pg 494-498 allows government to define mental illnesses and what services will be allowed to treat, again rationing this care.

    II. OVERVIEW of HOW OBAMACARE IS & WILL BE PHASED IN

    Obamacare was passed and signed into law on March 21, 2010.
    -- Maximum Out-of-Pocket Premium as Percentage of Family Income and federal poverty level
    -- PPACA includes numerous provisions to take effect over several years beginning in 2010. Policies issued before particular provisions take effect are grandfathered from many of these provisions, while other provisions may affect existing policies.
    -- Guaranteed issue will require policies to be issued regardless of any medical condition, and partial community rating will require insurers to offer the same premium to all applicants of the same age and geographical location without regard to gender or most pre-existing conditions (excluding tobacco use)
    -- A shared responsibility requirement, commonly called an Individual Mandate, requires that all individuals not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs, purchase and comply with an approved private insurance policy or pay a penalty, unless the applicable individual is a member of a recognized religious sect exempted by the Internal Revenue Service, or waived in cases of financial hardship.
    -- Health insurance exchanges will commence operation in each state, offering a marketplace where individuals and small businesses can compare policies and premiums, and buy insurance (with a government subsidy if eligible).
    -- Low income individuals and families above 100% and up to 400% of the federal poverty level will receive federal subsidies on a sliding scale if they choose to purchase insurance via an exchange (those at 150% of the poverty level would be subsidized such that their premium cost would be 2% of income, or $50 per month for a family of four).
    -- The text of the law expands Medicaid eligibility to include all individuals and families with incomes up to 133% of the poverty level, and simplifies the CHIP enrollment process. In National Federation of Independent Business v. Sebelius, the Supreme Court effectively allowed states to opt out of the Medicaid expansion, and some states have stated their intention to do so. In states that choose to reject the Medicaid expansion, individuals and families at or below 133% of the poverty line, but above their state's existing Medicaid threshold, will not be eligible for coverage; additionally, subsidies are not available to those below 100% of the poverty line. As many states have eligibility thresholds significantly below 133% of the poverty line, and many do not provide any coverage for childless adults, this may create a coverage gap in those states.
    -- Minimum standards for health insurance policies are to be established and annual and lifetime coverage caps will be banned.
    -- Firms employing 50 or more people but not offering health insurance will also pay a shared responsibility requirement if the government has had to subsidize an employee's health care.
    -- Very small businesses will be able to get subsidies if they purchase insurance through an exchange.
    -- Co-payments, co-insurance, and deductibles are to be eliminated for select health care insurance benefits considered to be part of an "essential benefits package" for Level A or Level B preventive care.
    Changes are enacted that allow a restructuring of Medicare reimbursement from "fee-for-service" to "bundled payments."

    Summary of Funding
    -- PPACA's provisions are intended to be funded by a variety of taxes and offsets. Major sources of new revenue include a much-broadened Medicare tax on incomes over $200,000 and $250,000, for individual and joint filers respectively, an annual fee on insurance providers, and a 40% excise tax on "Cadillac" insurance policies. The income levels are not adjusted for inflation, with bracket creep eventually increasing taxes on middle incomes. There are also taxes on pharmaceuticals, high-cost diagnostic equipment, and a 10% federal sales tax on indoor tanning services. Offsets are from intended cost savings such as changes in the Medicare Advantage program relative to traditional Medicare.

    Summary of tax increases: (ten year projection) --
    --> Increase Medicare tax rate by .9% and impose added tax of 3.8% on unearned income for high-income taxpayers: $210.2 billion
    --> Charge an annual fee on health insurance providers: $60 billion
    --> Impose a 40% excise tax on health insurance annual premiums in excess of $10,200 for an individual or $27,500 for a family: $32 billion
    --> Impose an annual fee on manufacturers and importers of branded drugs: $27 billion
    --> Impose a 2.3% excise tax on manufacturers and importers of certain medical devices:$20 billion
    --> Raise the 7.5% Adjusted Gross Income floor on medical expenses deduction to 10%: $15.2 billion
    --> Limit annual contributions to flexible spending arrangements in cafeteria plans to $2,500: $13 billion
    --> All other revenue sources: $14.9 billion
    --> Summary of spending offsets: (ten year projection)
    --> Reduce funding for Medicare Advantage policies: $132 billion
    --> Reduce Medicare home health care payments: $40 billion
    --> Reduce certain Medicare hospital payments: $22 billion
    --> Original budget estimates included a provision to require information reporting on payments to corporations, which had been projected to raise $17 billion, but the provision was repealed.

    Provisions

    -- PPACA is divided into 9 titles and contains provisions that became effective immediately, 90 days after enactment, and six months after enactment, as well as provisions phased in through to 2020.
    Below are some of the key provisions of PPACA. For simplicity, the amendments in the Health Care and Education Reconciliation Act of 2010 are integrated into this timeline.

    Effective at enactment (2010):

    -- The Food and Drug Administration is now authorized to approve generic versions of biologic drugs and grant biologics manufacturers 12 years of exclusive use before generics can be developed.
    -- The Medicaid drug rebate (paid by drug manufacturers to the states) for brand name drugs is increased to 23.1% (except the rebate for clotting factors and drugs approved exclusively for pediatric use increases to 17.1%), and the rebate is extended to Medicaid managed care plans; the Medicaid rebate for non-innovator, multiple source drugs is increased to 13% of average manufacturer price.
    -- A non-profit Patient-Centered Outcomes Research Institute is established, independent from government, to undertake comparative effectiveness research.[44] This is charged with examining the "relative health outcomes, clinical effectiveness, and appropriateness" of different medical treatments by evaluating existing studies and conducting its own. Its 19-member board is to include patients, doctors, hospitals, drug makers, device manufacturers, insurers, payers, government officials and health experts. It will not have the power to mandate or even endorse coverage rules or reimbursement for any particular treatment. Medicare may take the Institute's research into account when deciding what procedures it will cover, so long as the new research is not the sole justification and the agency allows for public input.[45] The bill forbids the Institute to develop or employ "a dollars per quality adjusted life year" (or similar measure that discounts the value of a life because of an individual's disability) as a threshold to establish what type of health care is cost effective or recommended. This makes it different from the UK's National Institute for Health and Clinical Excellence.
    -- Creation of task forces on Preventive Services and Community Preventive Services to develop, update, and disseminate evidenced-based recommendations on the use of clinical and community prevention services.
    -- The Indian Health Care Improvement Act is reauthorized and amended.
    -- Chain restaurants and food vendors with 20 or more locations are required to display the caloric content of their foods on menus, drive-through menus, and vending machines. Additional information, such as saturated fat, carbohydrate, and sodium content, must also be made available upon request. But first, the Food and Drug Administration has to come up with regulations, and as a result, calories disclosures may not appear until 2013 or 2014.
    -- States can apply for a 'State Plan Amendment" to expand family planning eligibility to the same eligibility as pregnancy related care (above and beyond Medicaid level eligibility), through a state option rather than having to apply for a federal waiver.
    -- Adults with existing conditions became eligible to join a temporary high-risk pool, which will be superseded by the health care exchange in 2014. To qualify for coverage, applicants must have a pre-existing health condition and have been uninsured for at least the past six months. There is no age requirement. The new program sets premiums as if for a standard population and not for a population with a higher health risk. Allows premiums to vary by age (4:1), geographic area, and family composition. Limit out-of-pocket spending to $5,950 for individuals and $11,900 for families, excluding premiums.
    -- The President established, within the Department of Health and Human Services (HHS), a council to be known as the National Prevention, Health Promotion and Public Health Council to help begin to develop a National Prevention and Health Promotion Strategy. The Surgeon General shall serve as the Chairperson of the new Council
    -- A 10% sales tax on indoor tanning took effect.
    -- Insurers are prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays, in new policies issued.
    -- Dependents (children) will be permitted to remain on their parents' insurance plan until their 26th birthday, and regulations implemented under PPACA include dependents that no longer live with their parents, are not a dependent on a parent's tax return, are no longer a student, or are married.
    -- Insurers are prohibited from excluding pre-existing medical conditions (except in grandfathered individual health insurance plans) for children under the age of 19.
    -- All new insurance plans must cover preventive care and medical screenings rated Level A or B by the U.S. Preventive Services Task Force. Insurers are prohibited from charging co-payments, co-insurance, or deductibles for these services.
    -- Individuals affected by the Medicare Part D coverage gap will receive a $250 rebate, and 50% of the gap will be eliminated in 2011. The gap will be eliminated by 2020.
    -- Insurers' abilities to enforce annual spending caps will be restricted, and completely prohibited by 2014.
    -- Insurers are prohibited from dropping policyholders when they get sick.
    -- Insurers are required to reveal details about administrative and executive expenditures.
    -- Insurers are required to implement an appeals process for coverage determination and claims on all new plans.
    -- Enhanced methods of fraud detection are implemented.
    -- Medicare is expanded to small, rural hospitals and facilities.
    -- Medicare patients with chronic illnesses must be monitored/evaluated on a 3-month basis for coverage of the medications for treatment of such illnesses.
    -- Companies which provide early retiree benefits for individuals aged 55-64 are eligible to participate in a temporary program which reduces premium costs.
    -- A new website installed by the Secretary of Health and Human Services will provide consumer insurance information for individuals and small businesses in all states.
    -- A temporary credit program is established to encourage private investment in new therapies for disease treatment and prevention.
    -- All new insurance plans must cover childhood immunizations and adult vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP) without charging co-payments, co-insurance, or deductibles when provided by an in-network provider.