This document summarizes a report from a nonprofit health policy research organization on the status of the Affordable Care Act. It discusses polling that shows mixed views on the Supreme Court decision and law. It then outlines concerns from physicians that the law will limit their authority and increase regulatory burdens. Studies predict the law will increase costs and leave many uninsured. Overall the document argues the law faces widespread pushback and will likely see significant changes if not repealed.

1. A not-for-profit
health and tax policy
research organization
OBAMACARE:
What’s next?
Grace-Marie Turner
April 27, 2012
Docs 4 Patient Care
/GalenInstitute
www.galen.org

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12. Americans’ views
of Supreme Court decision
• 25% think the law should be upheld in full
• 38% would like the entire law thrown out
• 29% would like the court to strike down the
individual mandate
• 39% support health care overhaul in general
Source: Washington Post-ABC News Poll, April 8, 2012, http://www.washingtonpost.com/wp-srv/politics/polls/postabcpoll_04082012.html.

13. Do you think the health care reform plan that
Congress passed recently will increase, decrease,
or have no effect on each of the following:
Taxes
Federal Deficit
Health Care Costs
Insurance Premiums
Health Care
Quality
Source: AM&A, Resurgent Republic 1st Anniversary Survey of Likely Voters, April 25-27, 2010

15. A not-for-profit
health and tax policy
research organization
/GalenInstitute
www.galen.org

17. New taxes and fees in the health law

18. Studies show law fails to meet goals
• Health costs and health spending increase
• One-third of businesses may drop insurance
• Young people worried about high cost of
policies
• Doctors concerned about Medicaid
expansion and fraying the safety net
• Seniors are concerned about access to care
through Medicare and Medicare Advantage
• Up to 25 million will remain uninsured
www.galen.org

20. The AMA and practicing physicians
• The SGR Medicare payment fix was its
key bargaining chip
• The chance for a permanent fix is
missed; the president got the AMA
endorsement for an empty promise
• Budget concerns in the Congress mean
short-term fixes are likely to continue
www.galen.org

21. Physician concerns
• Questions about Accountable Care
Organizations
• Authority of HHS Secretary to set new
rules for quality of care
• Regulatory requirements that make
private practice much more difficult
• More burdensome record-keeping
www.galen.org

22. Anna Wilde Mathews, “When the Doctor Has a Boss,”, The Wall Street Journal Nov.
8, 2010, http://online.wsj.com/article/SB10001424052748703856504575600412716683130.html.

23. CRS previews impact on physicians
PPACA has the potential to change fundamental aspects of how
physicians organize, practice, and deliver care in the future.
• Some of these provisions create new structures and entities, like the
CMS Center for Medicare and Medicaid Innovation and the
Patient-Centered Outcomes Research Institute
• Others seek to develop alternatives to traditional fee-for-service payment,
such as the National Pilot Program on Payment Bundling, the shared
savings program (including the accountable care organization, or ACO,
model), or the value-based payment modifier under the physician fee
schedule
In the long run, these provisions combined have the potential to be the most
substantial of the PPACA and the Reconciliation Act modifications affecting
physicians and related providers.
Patricia A. Davis, Jim Hahn, Paulette C. Morgan, Julie Stone, and Sibyl Tilson, “Medicare Provisions in the Patient Protection and Affordable Care Act,
(PPACA): Summary and Timeline,” November 3, 2010, http://www.politico.com/static/PPM191_timeline.html.

24. Specific changes to watch
• IPAB — the Independent Payment
Advisory Board
• Patient-Centered Outcomes Research
Institute
• Physician Quality Reporting Initiative
www.galen.org

25. Action items
• Government requirements for use of
EMR
• Comparative effectiveness “guidelines”
• Payment policies that penalize those
with the top 10% of charges
www.galen.org

26. Predictions of the Medicare actuary
Under current law, CMS actuary Richard Foster
says Medicare is on track to pay physicians less
than Medicaid does, and this would lead to “severe
problems with beneficiary access to care.”
He predicts many Medicare providers will go
bankrupt if policies are unchanged. More than 40%
eventually would end up “shifting to negative profit
margins” and will either go out of business or stop
seeing Medicare patients altogether.
“House Budget Committee Hearing Highlights,” House Budget Committee, July 13, 2011, http://paulryan.house.gov/News/DocumentSingle.aspx?
DocumentID=251972. “Statement of Actuarial Opinion,” 2011 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal
Supplementary Medical Insurance Trust Funds, The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medicare Insurance Trust Funds,
May 13, 2011, https://www.cms.gov/ReportsTrustFunds/downloads/tr2011.pdf.

27. Some realities
www.galen.org

28. Who said this?
“You should never try to tell people what they
ought to do because all of their circumstances
are different.
“But if you give them very good timely
information, they are going to make their own
decisions in ways, in general, that are going to
be better for them and better for the system as
a whole.”
― Ron Kirby, transportation planning coordinator for the
Metropolitan Washington Council of Governments
Ashley Halsey III and Ed O‟Keefe, “Earthquake illustrates colossal challenge
of evacuating Washington, D.C.” The Washington Post, August 24, 2011.

29. Health care in 2012
• Legislation
Challenges to the law: 1099, CLASS and
IPAB
• Regulation
12,000+ pages so far
• Legal
U.S. Supreme Court decision in late June
• Political
2012 campaigns and elections
www.galen.org

30. Europeans going the other way
• Consumerism
• Value of private enterprise
and competition
• Doctor-patient relationship
• Decentralized
decision-making
www.galen.org

31. Opportunities ahead
This is not settled policy
A not-for-profit
health and tax policy
Major election before implementation
research organization
States will have a big say
This law will be changed, likely
significantly, if not repealed outright.
The American people want private
insurance, and they want to be in
charge of choices.
/GalenInstitute
Freedom. Innovation. Control.
www.galen.org

32. Why ObamaCare Is Wrong for America
How does the health care law
drive up costs?
Is your doctor really in charge of
your health care decisions?
Are your Constitutional rights
threatened?
Discover the law’s impact on
your life in a new book from
four nationally recognized
health policy experts
Published by Broadside Books,
an imprint of HarperCollins www.WrongForAmericaBook.com
www.galen.org

33. Grace-Marie Turner
A not-for-profit
health and tax policy
research organization
Galen Institute
703-299-8900
gracemarie@galen.org
twitter.com/GalenInstitute
facebook.com/GalenInstitu
te
Subscribe to our free email alerts at
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34. Americans agreed on goals for health reform…
• The U.S. needs health reform to:
– make coverage more affordable
– assure quality, and
– expand access to insurance
• Most people rate their own coverage as
good or excellent
• They want stability. Change is for
others.
www.galen.org

35. Early changes from the law
– Medical Loss Ratio
A not-for-profit
health and tax policy
research organization – Grandfathering rules
– “Free” preventive care
– Allowing “children” up to age 26 on
parent’s policies
– No annual or lifetime limits on
coverage
– Pools for pre-existing condition
policies
/GalenInstitute
www.galen.org – $250 for seniors with high drug costs

36. The health law’s main features
• Expands coverage to 30 million uninsured
• A new system of Exchanges to deliver subsidies
• States required to expand Medicaid
• Citizens required to purchase approved health insurance
• Most employers required to offer coverage
• Significant new federal regulation of the health sector
(with 159 new regulatory agencies and programs)
• Medicare cuts and changes
Financed by
• $575 billion in payment reductions to Medicare
• $550 billion new taxes and penalties
www.galen.org

37. Higher Costs
• Insurance rising 9% to $15,000/yr. in 2011
• Foster: “False more so than true” that law
will lower costs for taxpayers
• Latest CBO cost estimate: $1.76 trillion/10
yrs.
• Gruber: Premiums up to 30% higher than
without the law
Congressional Budget Office and the Joint Committee on Taxation, “An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable
Care Act,” November 30, 2009, www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf. Chief Medicare Actuary on President's health care claims: "I would
say false, more so than true,“ House Budget Committee, January 26, 2011, http://www.youtube.com/watch?v=XC9rhGWJA2w. “2011 Employer Health Benefits
Survey,” Kaiser Family Foundation/Health Research & Educational Trust, September 27, 2011, http://www.kff.org/insurance/092311nr.cfm.

38. “If you like your health insurance…”
• 51 to 80% of Americans will lose current
coverage, according to Obama admin. estimates
• CBO: Up to 20 million could lose job-based plans
• McKinsey: Up to 80 million will be forced to
change policies
• Child-only policies will vanish in 17 states
• 35 million more will move from job-based
insurance to taxpayer-subsidized exchanges
“Fact Sheet: Keeping the Health Plan You Have: The Affordable Care Act and „Grandfathered‟ Health Plans,” U.S. Department of Health and Human Services, HealthReform.gov,
http://www.healthreform.gov/newsroom/keeping_the_health_plan_you_have.html.
"CBO and JCT's Estimates of the Effects of the Affordable Care Act on the Number of People Obtaining Employment-Based Health Insurance," Congressional Budget Office, March 2012,
http://www.cbo.gov/publication/43082.
Shubham Singhal, Jeris Stueland, and Drew Ungerman, “How US health care reform will affect employee benefits,” McKinsey Quarterly, June 2011,
www.mckinseyquarterly.com/Health_Care/Strategy_Analysis/How_US_health_care_reform_will_affect_employee_benefits_2813.
“Health Care Reform Law‟s Impact on Child-Only Health Insurance Policies,” Senate Committee on Health, Education, Labor and Pensions, August 2, 2011,
http://www.help.senate.gov/imo/media/doc/Child-Only%20Health%20Insurance%20Report%20Aug%202,%202011.pdf.
Douglas Holtz-Eakin and Cameron Smith "Labor Markets and Health Care Reform: New Results," American Action Forum, May 27, 2010,
http://americanactionforum.org/sites/default/files/OHC_LabMktsHCR.pdf.
www.galen.org

39. Independent Studies
Obama administration actuary Rick Foster:
• $120 billion in fines for companies and individuals
• Government spending will increase by $311 billion
• Many on Medicare will have trouble getting care
CBO:
The law will raise some family premiums by
$2,100 in 2016 above what they would have
been without the reform law
Richard S. Foster, Chief Actuary, “Estimated Financial Effects of the Patient Protection and Affordable Care Act, as Amended,” U.S. Department of Health and Human
Services, Centers for Medicare & Medicaid Services, Office of the Actuary, April 22, 2010, www.cms.gov/ActuarialStudies/Downloads/PPACA_2010-04-22.pdf.
Congressional Budget Office and the Joint Committee on Taxation, “An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act,”
November 30, 2009, www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf.
www.galen.org

40. Widespread pushback
• Very real consequences
A not-for-profit
health and tax policy – Killing jobs, especially decimating the insurance broker
research organization
community
– 40% of doctors plan to leave practice
• Resistance from states
– Lawsuits to block individual mandate, Medicaid
expansion
– Balking at setting up exchanges or otherwise complying
• Impossible complexity
– CLASS Act collapse
– Enormous bureaucracy, benefit mandates, privacy
issues
/GalenInstitute – 12,000 pages of regulations -- so far
www.galen.org

41. Push-back coming from
• Doctors and patients
Losing control over medical decisions
• Small businesses and big employers
New taxes, penalties, and mandates
• States
Higher costs for Medicaid
• Consumers
Higher costs for insurance and fewer choices
• Seniors
Cuts to Medicare
www.galen.org

43. Sources: AHIP Center for Policy and Research, U.S. Census Bureau.