One who intends to leave others better off for his having existed.


Excerpts from my 3/26/2014 Yes Weekly Article; "On Medicaid Expansion in North Carolina" ACA, Obamacare, CBO, SGR and the Doc Fix

The problem with Medicaid expansion isn't that the services shouldn't be offered. The problem is recent health care reform didn’t fix the cost issues associated with our nation’s health care system.

Considering how many times the law has been “adjusted” since the Congressional Budget Office’s (CBO) last update, I have found assessing the financial implications of expanding Medicaid in North Carolina difficult.

On March 21, the Obama administration’s stated “the Affordable Care Act (ACA) reduces the deficit, saving over $200 billion over 10 years”.

...But the latest ACA deficit reducing accounting appears to no longer be operable.

The last CBO projections didn’t include changes and delays affecting total cost results instituted after December 2013, including delayed penalty revenues and patients retaining the ability to keep and/or purchase low cost catastrophic policies that were supposed to have been replaced with higher priced alternatives in 2014.

More enrollees signed up for 100 percent subsidized care than anticipated. The Obama administration’s math needed about 40 percent of 18 to 34 year-olds to offset the higher costs of older enrollees. The latest youth number is about 27 percent, and a good chunk might not necessarily be healthy.

According to the American Medical Association, Congress and both Bush and Obama didn’t enforce the Sustainable Healthcare physician Growth Rate (SGR) 16 times at a cost to taxpayers of $154 billion with what’s call the SGR “doc fix”.

The University of Chicago’s Vineet Arora wrote: “Because the ‘doc fix’ costs so much, it was removed from the calculation of the cost of the health reform bill to make it more likely that the [ACA] will pass.”

Former Associate Director of the White House Office of Management and Budget James Capretta wrote “While pushing ACA through Congress, President Obama ... proposed to add [the SGR “doc fix”] to the national debt, but he did not want those costs to count against [the] ACA, because they would explode the myth of deficit reduction. So his solution was to pass the “doc fix” in separate legislation. ...the President’s total bill for health care, with an unfinanced [SGR] “doc fix” shows deficits, not deficit reduction.”

In my view, “Obamacare” is a package of legislation, not just the ACA as has been widely publicized.

A March 2010 letter from the CBO to House Budget Committee Chairman Paul Ryan, Obamacare legislation including the ACA disclosed “enacting all three pieces of legislation would add $59 billion to budget deficits over the 2010–2019 period”. Mr. Ryan hasn’t said much about the issue since. According to, Ryan’s career to date health industry contributions total $1,636,911.

The health and insurance industry’s large political campaign contribution track record correlates to taxpayer funded subsidized healthcare having the highest price inflation of any sector of the economy since 2000.

December 9, 2010’s SGR “doc-Fix” altered ACA subsidy formulas. If the SGR cut scheduled for April 1, 2014 doesn’t occur, at least $140.4 billion of Obamacare’s expected 10-year deficit reduction math looks to be in jeopardy, as Medicaid payment levels are tied to some Medicare reimbursements and correlated to private health care premiums.

My understanding of CBO rules, is if the SGR repeal becomes permanent, the $140.4 billion then counts as deficit increasing, as opposed to its current state of legal limbo, under which the CBO doesn’t have to score the SGR as a deficit expense. The CBO did not reply to inquiries for comment.

I believe the ACA was passed without fixing what’s broken, but preserved the worst of it, making our fiscal situation even more precarious without public disclosure.

It feels like America’s health and insurance industries don’t maintain high profit margins by providing superior care and/or medicine, but by financing the political process with wealth transferred from patients and taxpayers.

In my view, many Democrats are just as guilty as some Republicans for allowing our health care system to become what appears to be a skimming operation. Some campaign contributions look like legal forms of extortion on the part of elected officials via the SGR “doc fix” among other extensions, as some healthcare and insurance industry donors appear to legally bribe legislators in exchange for artificially inflated taxpayer-funded profit.
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