40,000,000 Forms A-Filling: According to a report issued by the National Taxpayer Advocate, 40 million businesses will be affected by the health care law’s new 1099 paperwork mandate. This new information reporting provision requires vendors and small businesses to file Forms 1099 for any goods purchases that total over $600 in the aggregate over the course of a year—which will force all businesses, including small businesses, to file tax forms listing the amount of their annual transactions with vendors like their paper supplier, bottled water distributor, caterer, etc. In addition, the Taxpayer Advocate doubts that this massive new reporting burden on business will even result in improved tax compliance.
On the seventh day of Obamacare, the government gave to me:
7,400,000 MA Benes Losing: According to the Medicare actuary, enrollment in Medicare Advantage (MA) will be cut in half as a result of the health care law, from a projected 14.8 million in 2017 all the way down to 7.4 million. One insurer has already dropped out of the MA program entirely due to the law, meaning seniors will face fewer choice of plans. And those seniors who still have access to an MA plan will pay higher costs as a result of the Medicare Advantage cuts – the Medicare actuary projects an $873 per year increase in out-of-pocket costs for MA beneficiaries, thanks to the law.
On the sixth day of Obamacare, the government gave to me:
0 Oversight Hearings: Since enactment of the health care law in March, the Democrat majority in both chambers has failed to conduct any substantive oversight of the sprawling 2,700 page measure. The only health care hearing the Finance Committee held since the bill passed was an inquiry that barely lasted an hour, and at which Republicans “were not given enough time” to ask substantive questions.
On the fifth day of Obamacare, the government gave to me:
159 Boards and Programs: A prior analysis found that the health care law establishes 159 boards, bureaucracies, and programs. From entities like an institute to conduct comparative effectiveness research to the National Health Care Workforce Commission, these bureaucracies will serve to micro-manage the entire health care system, putting government bureaucrats between doctors and patients.
On the fourth day of Obamacare, the government gave to me:
16,500 IRS Agents: According to a report issued by the Republican staff of the House Ways and Means Committee, the Internal Revenue Service may need to hire as many as 16,500 new agents to police the various mandates imposed on the American people by the health care law.
On the third day of Obamacare, the government gave to me:
In case you missed it due to holiday plans or winter weather, the New York Times reported a very interesting story about the Administration’s efforts to expand end-of-life counseling in Medicare. (The Wall Street Journal has a follow-up story this morning that can be found here.)
What’s most interesting about this story is the way in which advocates of end-of-life counseling “though pleased, have kept quiet” regarding the regulatory change. In fact, the article quotes one supporter as sending the following message to end-of-life counseling advocates:
“We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ — e-mails can too easily be forwarded….Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.”
These developments of course raise interesting questions about both this particular change, and what it means for implementation of the health care law going forward:
If this provision is so innocuous, then why are its advocates hoping it goes unnoticed, and sending around e-mails asking that no one attract attention to it?
Why has Barack Obama’s Administration gone from promising health care negotiations would be televised on C-SPAN to hoping that potentially controversial provisions can be slipped into regulations without drawing public attention?
When the Times article notes that this “strategy may become more prevalent in the next two years,” what other types of controversial provisions will the Administration attempt to implement through regulations that it could not enact by law?
21 Federal Lawsuits: According to a website run by the Independent Women’s Forum, there are currently 21 separate lawsuits in federal court challenging some or all of the health care law. In one of the more prominent cases, Virginia Judge Henry Hudson struck down the law’s controversial individual mandate earlier this month.
On the second day of Obamacare, the government gave to me:
As an end of year wrap-up of what’s been an eventful year in health care, it’s worth taking the time for a light-hearted tally of all the harmful effects of Democrats’ new and unpopular health care law. So on this December 25 – the first day of Christmas – we bring you the first in a series highlighting “The Twelve Days of Obamacare.”
On the first day of Obamacare, the government gave to me…A health insurance mandate “fee”: The health care law includes an unpopular mandate to purchase government-defined insurance – a mandate that candidate Obama opposed when he was running for President. And even though President Obama last year “absolutely” rejected the notion that forcing individuals to buy a product constituted a tax increase, the Obama Justice Department is now attempting to defend the mandate’s unprecedented imposition of federal power on the grounds that the mandate is a constitutional tax imposed by Congress.
Amidst the end-of-year flurry on Capitol Hill, the Administration released its proposed regulations on rate review of “unreasonable” premium increases on Tuesday – and tucked within its 136 pages are some interesting provisions ensuring that AARP’s lucrative Medigap supplemental insurance policies will not be subject to the new scrutiny other insurers will receive. Here’s the relevant passage from pages 29-30 of the regulations (posted online here until they’re officially published in the Federal Register):
In addition, insurance coverage that meets the “excepted benefits” definition set forth in section 2791(c) of the PHS Act and 45 C.F.R. §144.103 would not be subject to these proposed regulations. While “excepted benefits” are not explicitly exempt from section 2794 of the PHS Act, they are exempt from other provisions of the PHS Act, as added by the Affordable Care Act. “Excepted benefits” do not appear to be the focus of the rate review provisions of the Affordable Care Act. Therefore, the proposed regulation would exempt “excepted benefits,” to allow for the consistent administration of the PHS Act with respect to these defined benefits.
Section 2791(c)(4) of the Public Health Service Act (linked here) specifically includes Medicare supplemental insurance in the definition of “excepted benefits” – meaning that AARP’s lucrative Medigap plans will be exempt from the rate review process. On a related note, it’s also worth noting all the other special exemptions Medigap policies received in the health care law – because the Administration’s position, noted in the passage above, is that all the other special exemptions granted to Medigap plans mean that the rate review regulations should not apply to them either:
EXEMPT from the prohibition on pre-existing condition exclusions, such that AARP can continue to impose waiting periods on vulnerable seniors with pre-existing conditions – as it does currently (Section 1201(2)(A), Page 81 of H.R. 3590);
EXEMPT from a $500,000 cap on executive compensation for insurance industry executives, so that AARP can give its CEO more than $1 million in annual compensation – over 78 times the average annual Social Security benefit of $12,738 (Section 9014, Page 1995 of H.R. 3590);
EXEMPT from the tax on insurance companies that will total more than $14 billion per year – even though according to its own financial statements AARP generated more money from insurance industry “royalty fees” than it received from membership dues, grant revenues, and private contributions combined (Section 10905(d), Page 2395 of H.R. 3590); and
EXEMPT from a requirement imposed on Medicare Advantage plans to spend at least 85 percent of their premium dollars on medical claims – AARP Medigap policies are currently held to a far less restrictive 65 percent standard, and the difference can be used to fund “kickbacks” to AARP paid out of the pockets of its senior citizen members (Section 1103, Page 49 of H.R. 4872).
Also of note: AARP’s comments on the rate review note that the organization “strongly supports giving regulators authority to review rates before they are implemented” – but yet say NOTHING about applying the rate review process to Medigap plans. And while AARP said it supports transparency in disclosing information relevant to rate calculations for other types of insurance, the exemption for Medigap plans means that AARP will not have to disclose the amount of “kickbacks” it obtains from the sale of each Medigap policy. (AARP’s Board Chair previously promised to disclose this information at a congressional hearing last year; however, AARP later reneged on this commitment made in an open hearing.)
So to sum up: The Administration believes that all the special exemptions granted to Medigap plans in the health care law allows them to create yet another exemption for Medigap plans in regulations – and the AARP supports transparency for other insurers, but not for itself. Merry Christmas indeed…
A couple of additional health care nuggets to pass along before the Christmas holidays officially commence:
First, the Wall Street Journal has an interesting editorial this morning rebutting PolitiFact’s claim that characterizing the health care law as a government takeover was the “Lie of the Year.”
Second, CBO yesterday released an interesting document highlighting its work on health care during the 111th Congress just concluded. There is no new information in the document – it’s a compilation of previously released scores, including for the law enacted and prior iterations of the measure – but it’s a “one-stop resource” of official budgetary information that could prove quite valuable in the Congress to come.
All that said, best wishes for a safe and Merry Christmas!