The Hubris Of Gov. Bill Walker’s Obamacare Medicaid Expansion In Alaska

Last week, Alaska Governor Bill Walker announced that he will bypass the legislative process and implement Obamacare’s Medicaid expansion by executive fiat.

Walker’s announcement should be no surprise to Obamacare proponents – after all, President Obama has maltreated his executive authority dozens of times to amend his signature law. But expansion may come as a shock to Alaska’s legislative leadership, who last month brokered an informal arrangement with the governor to put Medicaid expansion on hold until 2016.

The press conference Walker held last week was heavy on promises, but light on specifics. To hear the Walker administration tell it, Obamacare’s Medicaid expansion would be an economic elixir for a state budget hit hard by declining oil prices. It would help failing hospitals become whole again, a sentiment echoed by the long line of high-paid Alaska hospital CEOs brought in to praise the decision.

But Bill Walker is no magician and Medicaid expansion is far from magic.
Alaska Gov. Bill WalkerAlaska Gov. Bill Walker speaks at a news conference in Anchorage, Alaska, Thursday, July 16, 2015. Walker announced he intended to accept federal money to expand Medicaid coverage in the state. (AP Photo/Mark Thiessen)

Gov. Walker’s Obamacare Expansion Will Shrink Alaska’s Economy

Despite promises that Medicaid expansion will jumpstart the Alaskan economy, the governor’s Obamacare plan will actually discourage work and shrink the economy.

Much of the Walker administration’s rosy claims about Medicaid expansion and the economy come from an unyielding belief in the “multiplier effect.” In short, Walker believes that Medicaid expansion money is created out of thin air and every new dollar of government spending will create income for some people – in this case, hospitals and doctors who see Medicaid patients – and that income will be spent in local communities, generating jobs, sales tax revenue, and other economic activity.

But there is no magic pot of Obamacare money and the Walker administration is only looking at one side of the ledger. In fact, when the Congressional Budget Office looked at all aspects of Obamacare and its Medicaid expansion, it found that it would actually reduce economic growth.

Alaska’s Medicaid Expansion Will Discourage Work

Gov. Walker’s Obamacare Medicaid expansion will create a massive new tax cliff, where earning a single extra dollar means that Medicaid expansion enrollees could face hundreds or even thousands of dollars of extra costs if they try and move off the program.

That new welfare cliff is sure to depress employment. Peer-reviewed research of previous Medicaid expansions to able-bodied adults shows that expanding Medicaid will diminish work, dampen earnings, reduce labor-force participation and hurt the economy. Those conclusions are supported by the independent Congressional Budget Office, which confirms that Obamacare will cause millions of working-age adults to drop out of the labor force or reduce their hours, ultimately reducing economic output.

In Alaska, nearly 4,000 able-bodied adults could drop out of the labor force entirely, with many more reducing hours to avoid the welfare cliff.

Walker’s Obamacare Medicaid Expansion Will Cost More Than Promised

Alaska policymakers can also expect Gov. Walker’s Obamacare expansion to cost far more than projected.

First, the Walker administration appears to be greatly underestimating potential enrollment, masking the true cost to taxpayers. His administration is predicting just 20,000 able-bodied adults will sign up for Medicaid expansion next year, far below the 41,000 expected by the Lewin Group.

Worse yet, it’s even lower than enrollment projected by the Urban Institute, which has consistently underestimated Medicaid expansion enrollment in other states.

In Washington state, for example, actual enrollment was more than double what the Urban Institute projected.

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On Sunday, the Associated Press released a damaging review of more than a dozen states that signed up for Obamacare’s Medicaid expansion.  In those states, enrollment has surged way beyond projections and lawmakers warn that added costs could mean less money available for education, pensions and other critical services.

A separate analysis of 17 Medicaid expansion states found actual enrollment exceeded states’ official projections by an average of 91 percent in 2014.

Worse yet, enrollment also exceeded states’ maximum enrollment projections in all 17 states. In several states, enrollment even exceeded the entire projected eligible population. Given the assumptions in Gov. Walker’s cost estimates, Alaska budgeters can expect a similar fate.

Gov. Walker is also predicting far lower costs to actually cover able-bodied adults than other consultants or that experience would suggest reasonable. The Lewin Group, for example, predicted these adults would cost $9,708 to cover in 2016. But Gov. Walker is promising to cover them for just $7,250.

Walker’s estimates assume that the cost to cover childless adults under Obamacare’s Medicaid expansion is similar to the cost of covering low-income parents currently in the Medicaid program.  But just this month, the Obama Administration released areport showing that costs to cover these newly eligible adults are far more than expected.

This confirms earlier research commissioned by CMS, finding that childless adults under Medicaid expansion could cost up to 60 percent more than low-income parents in Medicaid today. Other Medicaid expansion states have underestimated coverage costs, and the results have proven disastrous.

Problem #1 for Walker: Obamacare’s Medicaid Expansion Is a New Program

Gov. Walker claims he can expand Medicaid under Obamacare because of a quirk in Alaska law. Walker claims that he can legally accept federal funds without legislative approval, but only if the federal funds are used for an existing program and if no additional state general funds are required.

In NFIB v. Sebelius, 26 states – including Alaska – argued that Obamacare was unduly coercive because it required states to either implement Obamacare’s Medicaid expansion or else lose all federal funding for the existing Medicaid program.

But, as the Supreme Court of the United States held in NFIB, Obamacare’s Medicaid expansion is not simply expansion of an existing program. It’s the creation of an entirely new program. The Court deliberately drew a bright line between the existing Medicaid program and the “new program” offered to the states under Obamacare. Unfortunately, Gov. Walker is ignoring this fact in his quest for unilateral Medicaid expansion.

Problem #2 for Walker: Alaska Will Likely Have to Spend More to Pay for Expansion

Gov. Walker claims that he won’t require general funds to expand Medicaid in 2016, because the federal government will cover the benefit costs of expansion and he can cover administrative costs by siphoning $1.6 million from the Alaska Mental Health Trust Authority.

But will $1.6 million really cover all of Alaska’s costs to administer Obamacare’s Medicaid expansion? It’s not likely.

Gov. Walker estimates that administrative costs will amount to just 2 percent of the total cost of Medicaid expansion, or roughly $158 per enrollee. Historically, administrative costs have averaged more than 8 percent in Alaska. According to Gov. Walker’s own Office of Management and Budget, taxpayers are spending $696 per enrollee on administrative costs for those on Medicaid today.

Gov. Walker appears to be deliberately underestimating Medicaid expansion enrollment, benefit costs, and administrative costs so he can bypass the legislature and unilaterally expand Medicaid.

There simply will not be enough money in Alaska’s Mental Health Trust Authority to pay for Medicaid expansion without going back to the legislature for more money.

Alaska’s Legislature Should Block Gov. Walker’s Unilateral Obamacare Expansion

State lawmakers already passed a budget that prohibited the governor from acting unilaterally. The legislature controls the power of the purse and legislators know that accepting Obamacare expansion today means spending cuts, higher taxes or even tapping into the Permanent Fund to pay for skyrocketing costs down the road.

The governor cannot and should not make this decision on his own. It’s time for lawmakers to remind Governor Walker that Alaska has more than one branch of government and stop him from abusing his executive authority with a unilateral Obamacare expansion.

Legislators were right to turn down Obamacare’s Medicaid expansion. Now they must prepare to do whatever it takes to block Gov. Walker from implementing a policy they rejected.

By Josh Archambault and Christie Herrera-Mr. Archambault and Ms. Herrera are Senior Fellows at the Foundation for Government Accountability.

TWITTER: For more health care policy news and analysis follow me at @josharchambault

Iran deal opponents steal tactic from Obamacare fight

cardin_schumer

Senator Ben Cardin (D-Md.) with Senator Chuck Schumer (D-N.Y.) during a press conference on the Democrats reaction to changes to the TPP bill that failed on the Senate floor in a mostly party line vote on May 12, 2015. John Shinkle/POLITICO

Outside groups plan to target lawmaker town halls during August recess.

Opponents of the Iran nuclear deal are borrowing a tactic from the fight over Obamacare: taking a stand during town halls with members of Congress. The question is how heated the debate will get.

Many lawmakers are expected to hold town halls, coffee gatherings or similar events during the August recess, which falls within a 60-day period Congress has to review the internationally negotiated agreement with Iran. A similar series of gatherings held in 2009 during the congressional debate over health care reform intensified opposition to Obamacare and devolved into scuffles and shouting matches.

The Republican Jewish Coalition, one of several groups mobilizing against the deal, is distributing the town hall schedules of lawmakers to its 40,000 members so that they can attend and voice their opinions. The group’s “action alerts” target around 70 lawmakers, including Sen. Ben Cardin (D-Md.), the ranking member on the Senate Foreign Relations Committee.

“The most salient instinct in D.C. is survival and reelection, so the real pressure that you put on these guys is through the constituents,” said Mark McNulty, RJC’s communications director.

Groups such as RJC, the American Israel Public Affairs Committee and United Against Nuclear Iran are spearheading outside opposition to the deal. Supporters include J Street, the left-leaning Jewish organization, the Friends Committee on National Legislation, a Quaker group, and the National Iranian American Council.

The RJC’s McNulty compared the nuclear deal to Obamacare in that it’s a “monumental, a paradigm shift.” But while he acknowledged the nuclear deal wasn’t likely to spur the same level of passion as the health law — which directly hit people’s pocketbooks — he said the bitter history between Iran and the U.S., including the 1979 hostage crisis, still provokes visceral reactions from Americans.

“I think Americans have this instinctual feel that these people cannot be trusted and it’s wrong to make a deal where you’ve given up so much,” he said.

The deal requires Iran to dismantle much of its nuclear program in exchange for a suspension of many U.S. and international sanctions; the Republican-led Congress could pass a measure designed to prevent President Barack Obama from waiving the U.S. sanctions, but it is unlikely to achieve a veto-proof majority. Still, even many Democrats — some worried about alienating pro-Israel voters — have been cautious in discussing the deal.

The Obama administration could have dodged the potential town hall drama by reaching the deal with Iran before July 10, which would have given Congress only 30 days to review it — avoiding the recess period. White House officials are confident they will get the support they need to sustain a veto if it comes to that, but they are girding for a potentially bruising August as interest groups wage a war for public opinion over the deal, one expected to cost millions in advertising, petition drives, call-in campaigns and other efforts.

As far as town halls go, “certainly this is something we knew would be in the offing,” a senior administration official said. “That’s part of the reason we’re doing our own aggressive outreach.”

The administration has been in touch with women’s groups, peace activists, Jewish leaders and other constituencies it believes can help make its case for the deal to Congress, the official said, adding, “We’re doing this certainly in the hope and, frankly, the expectation that they will make their views on this vocal.”

The deal’s supporters say they’ve been anticipating the challenge posed by town halls and similar events, so they, too, are rallying their members to show up. The FCNL has even launched a web page that tracks lawmakers’ town hall schedules.

The 2009 public debates over Obamacare were often vicious affairs. Lawmakers who held gatherings with constituents were often heckled, shouted down and threatened. As supporters of Obamacare also showed up to defend the health law in some venues, there were scuffles and arrests.

Democrats alleged that much of the opposition was driven by conservative groups, including tea party affiliates, while Republicans insisted much of the fury was genuine and homegrown. There were reports of strategy memos by groups that encouraged attendees to be disruptive. In the years afterward, lawmakers reduced the number of town halls they hosted or changed the format to curb disruptions. Even now, many don’t publicize the gatherings widely or more than a few days in advance, activists said.

As supporters and opponents of the Iran deal send out instructions to their activists, they could find it tricky to predict how they will act, in part because for those with ties to the Middle East, the issue is personal. Many Jewish opponents of the deal view the Islamist regime in Tehran as an existential threat to Israel; many Iranian-American backers of the deal worry about relatives in Iran struggling due to a sanctions-battered economy.

“On one side we want people to be respectful, and on the other hand we know that intensity is going to be a big part of the perception of which side is stronger on this,” said Jamal Abdi, executive director of NIAC Action, the lobbying arm of the Iranian-American group. “We definitely don’t want people screaming and doing all that nonsense, but we do want people to be passionate about this.”

Asked if RJC’s members were being given instructions on how to behave at the town halls and other forums, McNulty said: “Our members are fine people. They’ll be able to express their opinions in appropriate ways.”

Lawmakers, meanwhile, say they are aware that the Iran agreement is going to complicate their upcoming vacation.

“This is democracy,” Cardin told reporters Wednesday in the Capitol. “Public opinion is important. People who engage us, petition their government, [are] important. The end result is what’s in the best interest of our country.”

Written by Nahal Toosi for Politico.

Florida rally prompted Trump’s plunge into politics

Donald Trump at Florida Tea Party RallyDonald Trump the icon, real estate mogul and reality TV star is a long-familiar national brand. But his launch as a politician arguably began at a tea party rally four years ago in Boca Raton.

In April 2011, the part-time Palm Beach resident stood before a cheering throng of thousands, some chanting “Run, Donald, run.”

Video clips of the event show Trump in pink tie, dark suit and distinctive pompadour, sounding a lot like a future candidate when he boasted of having “the qualities needed for the White House.”

Tea party leaders say the Boca rally fired up their movement and nurtured Trump’s ambitions, paving the way to his fast-rising campaign this year.

On Democrats: “I’m their worst nightmare.”
Since he began his (fake?) campaign for president in 2011, Donald Trump quickly turned into a quote machine, taking on anyone and everyone in his path. Here’s The Donald in his own words. (Reuters, Getty and Tribune photos)

“I think it was a turning point for Mr. Trump, though he didn’t run that time. It showed that he had a lot of support,” said Everett Wilkinson of Palm Beach Gardens, who organized the rally as then-chairman of the South Florida Tea Party. “Now that he has decided to run, the support that he gained there initially has become a whole lot more, to where he is the leading candidate.”

The tea party movement remains Trump’s base of support, propelling him to the head of the Republican pack in national polls.

Many in Florida and elsewhere scorn the blunt-spoken candidate, especially his tough talk accusing Mexican immigrants of bringing drugs, crime and “rapists” into the country along with some “good people.”

Some Miami leaders have declared Trump persona non grata, and Miami-Dade County commissioners voted to condemn his remarks.

But for the moment, Trump is dominating the Republican field.

A recent Washington Post/ABC News poll found that Trump was the favorite of 24 percent of registered Republicans and Republican-leaning independents. Following him were Wisconsin Gov. Scott Walker with 13 percent, former Florida Gov. Jeb Bush with 12 percent, former Arkansas Gov. Mike Huckabee 8 percent, U.S. Sen. Marco Rubio 7 percent and Dr. Ben Carson 6 percent.

Florida, the most populous swing state in the country, has become a launching pad for Republican presidential candidates. Five of the six leading Republicans are at least part-time Florida residents: Trump of Palm Beach; Bush of Coral Gables; Rubio of West Miami; Carson of West Palm Beach; and Huckabee, who lives near Destin.

Trump’s not the only candidate that the South Florida tea party movement thrust into state and national prominence.

A keynote speech at a similar tea party rally in West Palm Beach in April 2009 helped lift Rubio from a little-known legislator to a rising star and eventually U.S. senator. Former Rep. Allen West’s brief-but-spectacular political career also began with fiery anti-government speeches at South Florida tea party rallies.

Donald Trump versus President Obama
The Boca rally four years ago energized a “draft Trump” movement that implored him to run for president in 2012.

Trump’s popularity then and now depends on the same quality that has made him a national punch line: boastful, over-the-top, anti-government rhetoric that sounds like a joke to some but the honest truth to others.

“You have to appreciate how troubled those of us on the right are about our country,” said Sid Dinerstein, a former Republican chairman in Palm Beach County, who admires Trump but has not endorsed any candidate. “He thinks he can command an audience, and he has a resume. Maybe he can make a difference. I don’t blame him. If I had that resume and $9 billion, maybe I would run for president.”

Trump had made his presence — and his money — known in South Florida well before the 2011 rally.

His financial disclosure report filed with the Federal Election Commission this month lists assets including the Trump National Golf Club in Jupiter, worth $50 million; the Trump International Golf Club in West Palm Beach, worth more than $25 million; the Mar-a-Lago Club, worth $50 million; the Trump National Doral resort in Miami, worth more than $50 million; aircraft in Palm Beach worth more than $7 million; and residential property in Palm Beach worth more than $6 million.

In 2007, the Town of Palm Beach accused Trump of violating its zoning code by flying a super-sized 25-by-50-foot American flag from a 80-foot pole on his Mar-a-Lago estate-turned-club. In a legal settlement, the town agreed to drop its fines, which were mounting at a rate of $1,250 a day. Trump dropped his $25 million lawsuit, lowered the pole to 70 feet and anted up $100,000 for charities.

In 2009, he bailed out of a deal to open a 24-story luxury condo-hotel along Fort Lauderdale beach, a victim of the real-estate bust.

Many political observers assume Trump’s presidential aspirations also will go bust as his politically incorrect remarks sink in and voters take a closer look. But the tough-talking mogul has a loyal following, especially among older white conservatives.

That includes the community that rekindled his ambitions four years ago.

“Support in this county? For Donald Trump? It’s huge,” Dinerstein said. “A lot of old white guys like Donald. And this county has a lot of old white guys.”

wegibson@tribpub.com

Trump talk

“When Mexico sends its people, they’re not sending their best. … They’re sending people that have lots of problems, and they’re bringing those problems with us. They’re bringing drugs. They’re bringing crime. They’re rapists. And some, I assume, are good people.” June 16 announcement speech

“When was the last time anybody saw us beating, let’s say, China in a trade deal? They kill us. I beat China all the time. All the time.” June 16 announcement speech

“I will be the greatest jobs president that God ever created.” June 16 announcement speech

“The wall will go up, and Mexico will start behaving.” June 16 interview on Fox News

“The U.S. will invite El Chapo, the Mexican drug lord who just escaped prison, to become a U.S. citizen because our leaders can’t say no!” July 13 tweet

“[Sen. John McCain, R-Ariz.] is not a war hero. He’s a war hero because he was captured. I like people that weren’t captured.” July 18 speech in Iowa

“I have said things that I could’ve held back. But not that often, surprisingly not that often. But certainly there have been occasions.” July 19 on ABC’s “This Week”

Trump punch lines

“Who is giving Donald Trump money? That’s like giving your money to a pile of money.” — Jimmy Fallon

“Today, Donald Trump reaffirmed his stance against gay marriage: Marriage is between a rich guy and his much younger third wife.” — Conan O’Brien

“Presidential hopeful Donald Trump said yesterday that he has better hair than Sen. Marco Rubio — a claim that was recently disproven by wind.” — Seth Meyers

“The White House is saying Donald Trump has ‘zero percent chance’ of being elected. Isn’t that a little high?” — David Letterman

Trump visits Mexico border, claims Hispanics love him
Trump visits Mexico border, claims Hispanics love him
“And Donald Trump is here. Still.” — President Barack Obama

“Would you want to give him the nuclear codes? If he had a bad day, maybe he’d put ’em on the Internet!” — Sen. Lindsey Graham, after Trump disclosed Graham’s phone number.

“I think President Trump would be a very good thing for jobs in this country — specifically for my job here at this show.” — Jimmy Kimmel

Copyright © 2015, Sun Sentinel

5 Things We Still Don’t Know About Obamacare

                      Source: Social Security Administration via Facebook.

The Patient Protection and Affordable Care Act, known also as Obamacare, officially went into effect on Jan. 1, 2014, and to say that the ride has been bumpy would be a major understatement.

The first enrollment period between Oct. 1, 2013, and March 31, 2014, was marked by monumental signup issues for individual state exchanges as well as the federal government’s marketplace known as Healthcare.gov. Due to software and server issues, fewer than 400,000 people were able to successfully sign up via Healthcare.gov through the first two months when the Congressional Budget Office had projected that somewhere in the neighborhood of 1.4 million would enroll.

Of course, Obamacare also made quite the about-face following its disastrous start. Since December 2013 and through the entirety of its second full enrollment period between Nov. 15, 2014, and Feb. 15, 2015, Obamacare managed to enroll more than 11 million people. Per Gallup, the uninsured rate in the second quarter of 2015 fell to just 11.4%, the lowest on record since it began keeping tabs in 2008. This is also down from a peak of 18% in the quarter directly preceding the implementation of Obamacare.

Five things we still don’t know about Obamacare
On the surface, these figures might suggest that Obamacare is a success. But, in reality, there are still a lot of things we just don’t know about Obamacare.

1. We don’t know if the individual mandate will actually work
Arguably one of the biggest question marks surrounding Obamacare is whether the actionable component of the law, the individual mandate, will work.

The individual mandate is the portion of the law that requires individuals to purchase health insurance or face a penalty come tax time. The penalties increase with each passing year, jumping from the greater of $95 or 1% of a person’s modified adjusted gross income in 2014, to the greater of $325 or 2% of MAGI in 2015. The penalty will rise substantially once more in 2016 to the greater of $695 or 2.5% of MAGI before rising by the rate of inflation in 2017 and beyond.

                                Source: Flickr user Okko Pyykko.

Aside from the fact that the individual mandate isn’t well liked, there’s a real possibility that these penalties, which are designed to coerce healthier young adults to purchase health insurance, thus spreading insurers costs over a greater swath of the population, may not work.

For starters, the IRS has veritably no collection power. The IRS can’t garnish wages or seize property if someone owes the Individual Shares Responsibility Payment, the official name for the individual mandate penalty. All it can do is withhold the penalty from a taxpayer’s refund or ask nicely for the taxpayer to fork over the money.

The other big problem is that the penalties for noncompliance are peanuts compared to the cost of actually obtaining health insurance. In 2015, the average ISRP was $190 for some 6.6 million people. Compare that to the approximately $3,700 it costs on average per year to enroll in a silver plan and you can see why some consumers would just as soon take the penalty without thinking twice.

2. We don’t know when the legal challenges will cease
Last month, Obamacare was saved from what seemed like certain doom when the U.S. Supreme Court ruled six to three in favor of the defense in King v. Burwell. This case challenged the legality of whether the federal government could pay advanced premium tax credits to enrollees when the language of the ACA noted that only states were allowed to make subsidy payments. For now, Obamacare rolls on with few, if any, changes — but for how long?

                          Source: Supreme Court of the United States via Facebook.

Even with King v. Burwell in the books, there are still four pending lawsuits that seek to derail the entire program. For example, House of Representatives v. Burwell is challenging the current administration’s agreement to pay out $175 billion to insurance companies over the next decade to help offset their losses for taking on sicker individuals. The House of Representatives alleges that the money for this program was never properly appropriated. Even though this lawsuit may not stand a large chance of making it to the Supreme Court, who’s to say new legal challenges won’t arise and upset the established medium in the future?

3. We don’t know if Obamacare can survive much beyond the 2016 presidential election
Obamacare has survived technical glitches and legal challenges galore — the U.S. Supreme Court has directly saved Obamacare three separate times — but there’s no guarantee that the healthcare reform law has what it takes to survive much beyond the 2016 presidential election.

                                            Source: White House on Flickr.

As it stands now, the Republican Party, which is ideologically opposed to Obamacare as it’s currently written, controls both houses of Congress. With President Obama ending his second term, we might see another Democrat step into the role of commander in chief, or we could see a changing of the guard and usher in a Republican president. If Republicans controlled the Oval Office and both houses of Congress, it’s possible that Obamacare could be repealed or drastically altered from how we see it today.

4. We don’t know if Obamacare can stem the rising tide of medical costs
Obamacare was designed first and foremost to lower the number of uninsured individuals in the United States. Secondarily, though, it was also geared at controlling medical cost inflation. Obamacare does this by encouraging competition in its transparent marketplace exchanges and by creating easier access to medical care whereby insured individuals can see their primary care physician annually in order to catch life-threatening or chronic conditions early before they become costly later in life.

This plan of attack on medical costs sounds great on paper, but two major question marks stand in the way of medical costs remaining under control.

                                    Source: StockMonkeys.com via Flickr.

First, insurers still appear to possess a substantial amount of pricing power. Under Obamacare, insurers are required to submit their rate increase requests well in advance of the start of open enrollment, and any double-digit increases (and decreases) need to be explained in detail to the Office of the Insurance Commissioner in each respective state. The idea here is that the OIC can help wrangle down unreasonable insurer premium hike requests. However, the OIC can’t forcibly require insurers to lower their premiums. So if an insurer has justification to substantially boost prices, it can still do so with relative ease.

The other major problem is that medical care is growing more personal these days. A focus on molecular diagnostics and gene-based therapies aims to bring personalized and more efficient treatments to patients, but as you might have imagined, at a much higher cost than more traditional therapies. With few checks in place to keep pharmaceutical companies from pricing new drugs in the five- and six-digit annual cost range, Obamacare may be fighting a losing battle at reining in medical cost inflation.

5. We don’t know if Obamacare can truly excel without a universal Medicaid expansion plan
Finally, we can’t know for sure just yet if Obamacare can succeed without the support of all 50 states when it comes to expanding Medicaid.

Source: Flickr user LaDawna Howard.

Under the ACA, billions of dollars in federal money was made available to all 50 states so they could expand their Medicaid program to cover individuals making more than 100% of the federal poverty level but below 138% of the FPL. Currently, 29 states have taken the federal funds, while 21 states have chosen not to expand their Medicaid program. The reason given by the withholding states is that their expansion costs would be too great over the long term. Beginning in 2016 and extending through 2022, the federal government would begin paring back its assistance in the state-level Medicaid expansion from covering 100% of the full subsidies to just 90%, with states making up the remainder.

With 21 states choosing not to expand, including highly populated Texas and Florida, millions of low-income Americans are left in the so-called “Medicaid Gap.” They make too much to be completely covered by Medicaid but too little to afford health insurance even with subsidies. The inability of these millions of people to gain access to affordable healthcare still has the potential to keep Obamacare from reaching its goals.

Written by Sean Williams for The Motley Fool.

It’s Not About Trump – It’s About The Failures Of The Republican Establishment

The Republican establishment is in a panic about the rise of Donald Trump and how he donald-trumphas dominated the debate and set the agenda for the early stages of the Republican presidential nomination.

With the first debate only a few weeks away they are desperate to silence Trump and marginalize his issues, but every time they attack him his numbers go up.

What the Republican establishment, and the Washington political elite in general can’t seem to grasp is Trump’s support is coming from the same place in American politics that the 2009 Tea Party movement came from.

As I documented in my book TAKEOVER, the Tea Party movement came about as a rebellion against the Big Government Republican establishment and the entrenched leadership of the Republican Party.

It was the failure of the Republican establishment to fight Obama, as much as it was grassroots opposition to Obama’s policies, such as the bailouts, Obamacare and the growth of spending and the debt that fueled the rise of the Tea Party.

In 2009 country class voters looked at what Obama was doing and thought, “We’re losing our country and Republican leaders won’t even fight for it,” and the Tea Party movement was born.

And in the same way, the rise of Donald Trump as a contender for the Republican nomination is not about Barack Obama, Hillary Clinton and the Democrats.

It’s about the failures of the Republican establishment, especially the GOP’s Capitol Hill leadership, to do what they promised to do and fight Obama’s policies with all the tools the Constitution gives them.

What feeds Trump’s poll numbers is his willingness to tell it like it is and remind voters that the Republican establishment lied in 2014 and once elected did exactly the opposite of what they promised in the 2014 midterm campaign.

They promised to defund Obamacare – they fully funded it.

They promised to secure the border and end amnesty – they engaged in a transparent fraud on voters and backed down when Obama held his ground, so when it came time to pass the Department of Homeland Security appropriation they gave Obama everything he wanted, and then some.

They promised to block the Iran nuclear weapons program – instead they passed the Corker bill and all but guaranteed Iran’s radical Muslim theocracy will shortly become a nuclear armed state destabilizing the entire Middle East and threatening Israel with annihilation.

The list goes on, but you get the point. Voters don’t like the leaders of the Republican establishment, they don’t trust them because they’ve lied and failed to keep their campaign promises over and over and over again.

What Donald Trump is doing is holding up a mirror to the failures of the Republican leadership.

The reflection isn’t pretty – and Trump’s poll numbers show voters sure don’t like what they see.

Donald Trump is no movement conservative, but he’s giving voters an alternative to the Republican establishment that they’ve never had before and every attack from RINOs like Lindsey Graham and establishment Republican politicians like Rick Perry adds rocket fuel to Trump’s rise.

Richard A. Viguerie, called the “Funding Father of the conservative movement,” transformed American politics in the 1960s and ’70s by pioneering the use of direct mail as a means for conservatives to bypass the mainstream media. He serves as the chairman of www.ConservativeHQ.com. The author of a number of books on politics and the conservative movement, Viguerie’s latest book is TAKEOVER: the 100-year War for the Soul of the GOP and How Conservatives can Finally Win It.

Paying More And Buying Less: The Story Of Obamacare

ObamaCare storeAccording to the Wall Street Journal, insurance companies are seeking to raise their premiums by as much as 65 percent because the people who signed up “seem to be older and have more chronic conditions like diabetes or congestive heart failure than predicted.” Color me surprised.

There are two sources of this high degree of sickness: first, fewer healthy people have signed up for the exchange than were anticipated. For healthy people, particularly young people, some of the provisions of Obamacare just simply do not make sense as they provide too much coverage in wrong areas, making them too expensive to be worth the cost. As a result, these healthy people do not sign up, meaning that the average person in the exchange is sicker because there are too few healthy people around to decrease the average.

The actual enrollment numbers show this: in 2010, the CBO projected that 35 million people would sign up for Obamacare. Today, a mere 16.4 million have done so. Further, the Obama administration has stated that they need about 40 percent of the enrollment to be comprised of people between the ages of 18 and 34 to make the program work. As of 2014, roughly 25 percent of the Obamacare enrollees were in that age group.

The second source, however, is much more pernicious. Obamacare provides a means for one group of people to use taxpayer money to purchase their health insurance and, in turn, their health care. Because of this, some people are able to go to the doctor at a lower out-of-pocket cost than before. While on the surface this looks like a victory, at a deeper level it is nothing more than a counterproductive failure, especially when coupled with America’s still-broken healthcare system.

For example, by lowering the out-of-pocket expense of going to the doctor, some people are steered away from using home remedies such as bed rest, drinking fluids, and cough medicine, which may have been sufficient to address their ailments. Because people do not face the full cost of going to the doctor, they are more likely to do so. This can only lead to higher prices at the doctor, which inevitably lead to higher insurance prices. Indeed, this is exactly what was found in a 2015 study by the research division of Health Pocket. Further, thanks to America’s ailing medical liability system, the number of defensive tests conducted at hospitals increases as more people go to the doctor, further increasing the cost of a visit to the doctor and, in turn, the cost of health insurance.

That insurance companies are seeking congressional approval to increase their rates is no surprise whatsoever. Obamacare does nothing more than allow every American to reach into the pockets of every other American to pay for their health care. That health care becomes more expensive to society, not less, is the inevitable result of everyone reaching into everyone else’s pockets to pay for their own health care and to pay for more unnecessary, defensive medical tests and procedures.

Tags: CBO, David Hebert, Health Insurance, Health Pocket, Obamacare, Wall Street Journal

 

Roberts’ ObamaCare ruling could be boon for Republicans

FILE: Nov. 29, 2013: The HealthCare.gov website is photographed in Washington, D.C. (AP)

Supreme Court Justice John Roberts infuriated conservatives when he wrote the recent opinion to uphold ObamaCare.

But secretly, many Republicans in Congress are thanking Roberts from saving conservatives from themselves. And if they aren’t sending him balloons and flowers now, they may do so by the end of the year.

The King v. Burwell health care case centered on a four-word phrase: “established by the state.”

The Affordable Care Act (ACA) granted states the opportunity to set up local exchanges to process health care plans. But residents of states that didn’t establish exchanges could receive subsidies to use the federal system instead.

Thus, there was no exchange “established by the state” in those venues. So the question the high court examined was whether it was fair for residents of non-exchange states to score tax credits when the rest of the population was ineligible.

In its decision, the Supreme Court held that Congress “meant for those provisions to apply in every State as well.”

But what would have happened had the high court ruled it was unconstitutional to award people subsidies from non-exchange states?

“Chaos,” muttered one senior congressional Republican aide. “Any solution to the problem is going to have the right howling.”

Why? Because a vote to fix the problem would constitute a vote tacitly endorsing ObamaCare.

The Republican Party has engineered close to 60 congressional votes to repeal the law. Nobody knows the precise number because everyone has actually lost count.

Republicans in both bodies of Congress expressed optimism at constructing a health care fix that would pass. But they knew this could absolutely ignite the embers of the conservative base if they did anything short of scrapping the entire law.

Republicans feared a decision finding the credits unconstitutional would kick 7 million people off the subsidies and strip them of health coverage.

The GOP worried that the public might then turn on Republicans for stoking an effort that cost those people coverage — even if some are skeptical about the law.

GOP sources said they feared President Obama would have trotted across the country with a simple, one-page fix to the law to include those people. But there was consternation as to whether the Republican-led Congress could approve a “patch” piece of legislation, even though GOP leaders promised to advance a plan.

“We want to give people a bridge from ObamaCare,” House Ways and Means Committee Chairman Rep. Paul Ryan said during an appearance on Fox News Channel before the decision.

But Ryan was circumspect when pressed on the same program about the minutiae of a GOP plan.

“We want to see what the (court’s) ruling is specifically so we can customize our response to the actual ruling,” he said. “That plan will involve making sure people have assistance as we transition to give people freedom from ObamaCare.”

Prior to the high court decision, Ryan spoke privately with members about giving block grant money to states to give them the ability to set up their own system to protect Americans for two years until a possible Republican Congress and Republican president could set up an ACA alternative. Most Republicans liked what they heard.

Ryan summoned Health and Human Services Secretary Sylvia Burwell (the “Burwell” in King v. Burwell) before the Ways and Means Committee in mid-June. The Wisconsin Republican blasted Burwell after the session.

“They (members of the administration) still refuse to entertain the notion that their health care law may be struck down by the Supreme Court. And they refuse to acknowledge they are even thinking about a backup plan. And that’s unfortunate,” Ryan said.

A reporter followed up, asking Ryan about crafting his substitute.

“We are putting the final touches on it. Dotting the I’s. Crossing the T’s,” he replied.

Ryan may not have been willing to cough up the GOP legislative construct to the press corps then. But at the hearing, he insisted that Burwell publicly reveal what the administration would do if the court struck down the subsidies.

“Is the president going to be willing and flexible to work with Congress to fix this mess and negotiate with Congress?” Ryan asked Burwell.

“To solve that problem, the critical decisions are going to sit with the Congress,” Burwell told the chairman.

Ryan later predicted that if the Supreme Court tossed the subsidies, Obama could “put concrete around his ankles and say, ‘It’s my law or nothing.’ ”

Rep. Kevin Brady, R-Texas, also tried to pry loose some answers from Burwell.

“Will the president sign legislation other than merely extending the subsidies to federal exchanges?” he queried.

“I think it’s very hard for me to answer a question about hypothetical legislation,” responded Burwell.

Michigan Rep. Sander Levin, the top Democrat on the Ways and Means Committee, upbraided Ryan for “never coming up with a single, comprehensive alternative after all of these years.”

He also decried Republicans as “armchair critics” of the ACA.

Many Republicans privately acknowledge that the Supreme Court ruling helped them sidestep an immense fight over health care — the trickiest parts including the navigation of fissures inside their own party.

But the fight isn’t over.

There’s an important congressional vocabulary term everyone will start to hear a lot about over the next few weeks. It’s called reconciliation — a very special type of reconciliation, something known on Capitol Hill as “budget reconciliation.”

The congressional budget process is an exclusive bit of parliamentary infrastructure, separate from most other legislation.

Housed inside the annual budget machinery is “reconciliation.”

Reconciliation can be used to sync up spending, revenue and adjust the debt ceiling. Article I, Section 7 of the Constitution dictates that bills with revenue implications must start in the House. So the reconciliation vehicle originates in the lower chamber. But the real impact of reconciliation lies in the Senate.

The Senate’s fundamental glory is an unlimited amendment process and unlimited debate. That’s what gives rise to filibuster. But the budget process limits debate, curbs most amendments and requires but a simple majority to adopt legislative items. Thus, there is no way to filibuster something tucked into a budget reconciliation package.

Republicans now hold 54 seats in the Senate. Under conventional rules, Democrats could filibuster health care legislation. Vanquishing a filibuster would require a coalition of 60 Republicans and Democrats. Republicans know this. But since Obama signed the ACA into law in 2010, Republicans never controlled the Senate until this year.

Republicans would struggle to even put a health care bill on the floor right now. Sixty votes are necessary to hurdle the first filibuster blocking the measure from coming to the floor. Another round of 60 is required to shut off all debate and finish a bill. But that’s not the case with reconciliation.

There’s a lot of chatter now of putting a repeal of the ACA in a reconciliation measure later this year on the floors of the House and then the Senate. And Democrats can’t do anything about it.

Moving a health care bill through the House is simpler than in the Senate. But reconciliation grants the Senate the possibility to approve a repeal bill. That’s happened in the House umpteen times since 2011. But never in the Senate.

Undoubtedly, Obama would veto such a bill. But that’s what Republicans want. A dare. They want to deposit a full repeal bill on the president’s desk and dare him to veto it. And if he doesn’t, what have Republicans accomplished?

A lot.

To wit:

Congressional Republicans will have bypassed a catastrophic meltdown in the nation’s health care system because of the Supreme Court ruling in King v. Burwell. Mayhem may have descended on the Capitol had the High Court ruled that the subsidies were unconstitutional.

Republicans will have forced the president to veto a repeal of ObamaCare. But since they know they don’t have the votes to override the veto (a two-thirds vote in both bodies of Congress), Republicans haven’t necessarily had to produce an alternative health care bill. Such legislation remains a unicorn. And even if it does exist, this is a fractious issue in the Republican Party.

Republicans will have made Democrats from swing districts and states who face challenging re-elections to either vote to override the veto or side with the president.

Message masters at the National Republican Congressional Committee and National Republican Senatorial Committee will be more than happy to record those roll call tallies. The NRCC and NRSC will then integrate those votes into campaign ads against those lawmakers next year.

In short, some Republicans may seethe publicly at Chief Justice John Roberts now. But they could be sending him balloons and flowers later.

And here’s the Supreme Court address if they need it: 1 First Street, NE Washington, DC 20543.

Written by  for FoxNews

Odd way hundreds of homeless signed up for Obamacare

Brother can you spare some ObamaCareBrother, can you spare some Obamacare?

Giant insurer Aetna has severed ties with a North Carolina agent after questions were raised about his sales of Obamacare health plans to hundreds of homeless people in both North Carolina and South Carolina. The agent reportedly encouraged applicants to list income they supposedly expected to make during the year from barter, panhandling and illegal street hustling, such as drug sales and prostitution, on their coverage applications that he submitted.

Those sales by Charlotte-based agent Will Kennedy are under scrutiny by both state and federal regulators because of the question of whether some of those people may not actually be eligible for thousands of dollars of federal subsidies that are used to pay for each of their plans each year.

Obamacare Affordable Care Act

Andrew Harrer | Bloomberg | Getty Images

Those subsidies can leave low-income enrollees paying little or nothing in monthly premiums for the plans that were sold on HealthCare.gov, the federal Obamacare marketplace.

Read More: ‘Skimpy’ health plans for Obamacare customers

To qualify for those subsidies, a person must have at least $11,700 in projected income for the year, and Kennedy reportedly admitted filing a “large number” of applications from homeless people projecting just that amount of income, according to the Charlotte Observer. More than 600 plans that Kennedy sold in the Carolinas are under scrutiny.

If they make less than that level, people are not eligible for the subsidies. And most if not all of them also would be ineligible for government-run Medicaid, because North Carolina and South Carolina have not expanded eligibility for that program under the Affordable Care Act.

The customers whom Kennedy signed up also were placed in plans with high deductibles, potentially leaving them personally responsible for thousands of dollars in out-of-pocket health costs—and rendered ineligible for free medical services in North Carolina because they now have private insurance.

Kennedy, 43, reportedly paid people to get homeless people to sign up, and stood to collect a total of as much as $9,000 a month in commissions from the amount of plans that were sold.

Aetna’s termination of its relationship with Kennedy comes the same week as the U.S. Government Accountability Office revealed that its investigators had submitted Obamacare applications for 12 fictitious people, 11 of whom were approved for subsidized covered by HealthCare.gov, the federal Obamacare marketplace. Those 11 non-existent people were automatically re-enrolled in coverage this year.

CNBC revealed this week that TaxAudit.com, a leading tax audit defense company, had seen a very low rate of queries from the Internal Revenue Service about Obamacare-related tax issues for the company’s clients. They said the IRS was not challenging any customers on claims they had health coverage as required by the Affordable Care Act, or any customer who was claiming an exemption from that rule, or any customer who had received an Obamacare subsidy and filed forms that purported to justify the amount they received. Instead, only customers who got subsidies but did not file required forms were being questioned, TaxAudit.com said.

Read More: These two health plans more popular than Obamacare

In June, the Charlotte Observer reported that North Carolina officials began looking into Kennedy’s sales in April after a San Francisco health insurance software company reported “suspected fraud” when Kennedy used its software to sign up more than 600 people in North Carolina and South Carolina in just two days, with “most of them listing a projected income of $11,700 and many with addresses that turned out to be facilities for the homeless.”

Kennedy, who sold Aetna’s CoventryOne plans, told the paper in June, “What I have done, and what I make no apology for, is to work diligently to inform low-income individuals about their rights under the ACA and to help those who qualify obtain the health insurance for which they are eligible.”

Kennedy also told the Observer that he had recruited a team of people to solicit business from homeless people with the message that if the homeless thought they could make $33 per day from sources including handouts, barter or prostitution or drug sales, that they could get free Obamacare coverage.

“It was all under my direction. I believe in what I’m doing,” Kennedy said.

Kennedy did not immediately respond to requests for comment from CNBC.

Aetna spokesman Walt Cherniak told CNBC, “Aetna takes these allegations very seriously.”

We have investigated the matter and have terminated our business relationship with Mr. Kennedy,” Cherniak said. “We also are assessing whether further actions are appropriate.”

Read More: Obamacare tax audits few and far between

Cherniak didn’t answer CNBC’s questions about how many people were covered by Aetna plans sold by Kennedy, or whether that coverage remains in effect.

A spokesman for the federal Centers for Medicare and Medicaid Services, which oversees Obamacare and HealthCare.gov, told CNBC,”We take any allegations of fraud or abuse seriously and are working with the state to investigate and learn more about this issue.”

“The marketplace verifies consumers’ information in their application with our trusted data sources and gives consumers a chance to provide more up to date information where there is a conflict between their applications and the data sources,” said Aaron Albright, the CMS spokesman. “We are committed to helping individuals and families get the financial assistance and Health Insurance Marketplace coverage they are eligible for while protecting taxpayer dollars at the same time.”

A spokesman for the IRS, which issues Obamacare subsidies, had no immediate comment when contacted by CNBC.

To read the Charlotte Observer’s stories about Kennedy click here, and here.

Written by  for CNBC.

Court’s reasoning in Obamacare case should concern everyone

Demonstrators at the Supreme CourtIn a case destined to live in infamy, the United States Supreme Court in King vs. Burwell rewrote federal law in order to accomplish the political goal of preserving the Affordable Care Act. While many are pleased with the outcome, the court’s reasoning should concern everyone, regardless of political ideology.

The text of the ACA is clear that subsidies from the federal government are only available to individuals who purchase health insurance on an “exchange established by the state.” As it turned out, 37 states opted not to establish exchanges, preferring to instead rely on the federal government to do it for them, or using a joint state-federal exchange.

Nevertheless, the Obama administration decided to offer subsidies to every state, including those who did not establish their own exchanges. Multiple lawsuits were filed against the administration, arguing that according to the plain language of the ACA, subsidies could only go to people who buy insurance from state exchanges.

The issue before the Supreme Court was thus straightforward: does the word “state” mean “state,” or does it mean “state and the federal government?” Not many cases have had such a disparity between a question fraught with immense political and policy consequences and a very easy and straightforward legal issue. In a 6-3 decision that turned logic and the English language on its head, the court ruled that when Congress used the phrase “exchange established by the state,” it actually includes exchanges established by the federal government.

The opinion’s author, Chief Justice John Roberts, once promised to be an umpire, calling “balls” and “strikes” on the court. Yet for the second time in three years, the chief expanded the strike zone in order to save the Affordable Care Act. In his opinion, he acknowledged that “[t]he Affordable Care Act contains more than a few examples of inartful drafting.” However, this created a “problem” in Roberts’ view because “[i]f we give the phrase …its most natural meaning, there would be no ‘qualified individuals’ on Federal Exchanges.”

Consequently, to justify reaching a conclusion that contradicts the text of the law, the court imposed the following jagged syllogism. Congress intended the ACA to increase the amount of people covered by insurance. But if we read the ACA as written, it might result in less people having insurance. Therefore, the court must rewrite the ACA. Q.E.D.

In the 2012 decision upholding the ACA, Roberts infamously wrote that, “[i]t is not our job to protect the people from the consequences of their political choices.” That formulation miscasts the question. The court was not being asked to protect the people from their choices; it was being asked to assess whether Congress had the constitutional authority to pass the Affordable Care Act. This time around, in King vs. Burwell, the chief justice again resorted to judicial legerdemain by stating that “the power to make the law rests with those chosen by the people …we must respect the role of the Legislature, and take care not to undo what it has done.”

But by going along with the executive branch’s rewriting of inconvenient statutory language, the Supreme Court completely undermined the principles of our government. Congress, according to the U.S. Constitution, is the only branch of government vested with legislative powers. The founders recognized that when unelected judges rewrite laws, they are taking away the people’s right to speak through their representatives in Congress. Indeed, James Madison warned about one branch of government usurping the powers of another branch: “[t]he accumulation of all powers, legislative, executive, and judiciary, in the same hands …may justly be pronounced the very definition of tyranny.”

Sadly, the Roberts court once again passed off judicial abdication as judicial modesty. Our system of government is all the poorer for it.

Matthew Fernholz is an associate attorney at Cramer, Multhauf, & Hammes in Waukesha, practicing civil litigation. C.J. Szafir is associate counsel at the Wisconsin Institute for Law & Liberty, a nonprofit law and policy center. They are both graduates of Marquette University Law School.

Will Obamacare’s Cadillac Tax Threaten Your Health Insurance?

The Cadillac tax doesn’t have everyone feeling luxurious. Image: Wikimedia Commons.

The Patient Protection and Affordable Care Act, better known as Obamacare, was signed into law in early 2010. Yet even now, more than five years later, not all of the law’s provisions have come into effect. In particular, one element of the Obamacare legislation that has drawn attention recently involves what’s known as the “Cadillac tax” on high-value health-insurance coverage. The Cadillac tax isn’t scheduled to affect anyone until 2018, but already, the provision is drawing debate among politicians and policymakers on both sides of the Obamacare divide. To help give you more information about this tax and how it might affect you, let’s take a more in-depth look at the Obamacare Cadillac tax and its provisions.

What  the Obamacare Cadillac tax does
The Affordable Care Act’s stated purpose was to give more people access to health insurance coverage, but the Cadillac tax focuses on the other end of the spectrum: those workers whose employers provide extremely comprehensive and costly health insurance policies. Under the Cadillac tax, beginning in 2018, employers have to pay a 40% excise tax on the costs of each employee’s health insurance to the extent that it exceeds a certain threshold. For individual policies, the starting threshold amount is $10,200. That amount rises to $27,500 for family coverage.

Proponents of the tax argue that those premium levels should affect a relatively small number of people when they take effect, according to current estimates. The average individual plan cost just over $6,000 in 2014, based on figures from the Kaiser Family Foundation, while family plans weighed in at around $16,800. Yet the problem with using averages is that it ignores one of the fundamental economic truths about health-insurance coverage costs: coverage for older workers inevitably costs more than identical coverage for younger workers, because of the higher risks of the older pool of insured workers.

Also favoring the tax are those who want workers to have a closer connection to the costs of the healthcare they use. Economists have noted that when people wrap most of the cost of their healthcare into insurance premiums, they have less incentive to avoid incurring expenses for unnecessary care. When you’re responsible for a higher copayment or greater percentage of the overall costs of services, then you’re more likely to think carefully about whether you actually need those services.

Why opponents don’t like the Obamacare Cadillac tax
On the other end of the debate, the most interesting thing about the Cadillac tax is that from a political standpoint, many of those who have supported Obamacare in general are lukewarm at best about imposing the tax. Some of those most opposed to the tax are labor unions, whose efforts to negotiate high-quality health benefits are encountering resistance from employers facing the added expense of paying the tax. Others note that having borne the costs of providing coverage under Obamacare, it would create a budgetary imbalance to repeal the Cadillac tax and give up an estimated $90 billion in potential revenue to help pay for the program over the next decade.

Moreover, the Cadillac tax doesn’t just look at health insurance premiums. It also includes employer contributions to health savings accounts, flexible spending accounts, and some other tax-favored forms of benefits related to healthcare. Many of these features were designed specifically to encourage workers to pay more attention to their healthcare costs, so opponents would argue that penalizing employers for using them seems inconsistent with the purpose of the Affordable Care Act.

Another objection to the Cadillac tax is that its impact could get more pervasive over time. Increases in the premium-cost thresholds are tied to the Consumer Price Index, and over the long run, premium costs have tended to rise at a much higher rate than this general inflation benchmark. The result is that employers could find an increasing number of their employees are generating Cadillac tax liability.

What to expect from your employer
Policymakers believe that the natural response from employers will be to reduce benefits far enough to avoid triggering the excise tax under the Obamacare Cadillac tax provisions. The simplest ways to do so would be to increase deductibles that workers are responsible for paying before coverage kicks in, to boost copays for doctor visits and drug prescriptions, and to remove nonessential benefits from plan coverage entirely or reducing the percentage of costs that the policy will cover.

That said, employers already have an economic incentive to move in the direction of reducing their healthcare costs even without the Cadillac tax. Many have already taken some of the steps listed above to reduce their benefits-related expenses, and more will likely join their ranks more as a broad-based effort to keep costs down rather than specifically seeking to reduce future Cadillac tax liability.

With a couple more years before the tax takes effect, you can expect the Obamacare Cadillac tax to remain a hot-button issue for the foreseeable future. If your employer starts making changes to your healthcare plan, though, you should keep the Cadillac tax in mind — and assess whether it’s really the motivation for the change or merely an excuse to cut costs and boost profits more broadly.