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Thursday, October 24, 2013

Ten Things to Expect from Obama Care in 2014

By Elizabeth Lee Vliet, M.D.

It's been clear to anyone paying attention that the October "rollout" of Obamacare has been a turbulent, confusing disaster. Sloppy IT systems and technological failures combined to cripple Obamacare's sign-up systems. Security flaws put Americans at risk for identity theft.

In an almost comical understatement, President Obama summarized these massive failures as "a few glitches." I think that Luke Chung, IT expert and president of database solutions firm FMS, explained the situation much more accurately:

"What should clearly be an enterprise quality, highly scalable software application felt like it wouldn't pass a basic code review. It appears the people who built the site don't know what they're doing, never used it and didn't test it."

Chung went on to call it a "technological disaster."

Think about what this ineptitude means in the bigger debate about Obamacare. The administration spent 3½ years and $698 million of taxpayers' money to develop this software. They've known since earlier this year that the system wasn't ready to support the rollout of the exchanges. Yet they proceeded anyway, apparently unconcerned about their faulty software costing Americans millions of hours of frustration and lost productivity.

These same bureaucrats continue to assume more and more control of our medical care. What does their incompetence say about how they will handle making life-or-death medical care decisions?

Like a parasite taking over its host, Obamacare will commandeer almost 20% of our economy, crowding out private options. With 2014 fast approaching, what should we expect in its next phase?

Here's my list Top Ten list for 2014:

1. The expansion of Medicaid, with increased cost burden for taxpayers.

Medicaid is a combined state-federal program initially designed to help the neediest among us. But it has burgeoned to cover medical costs for about one in every five people. Today, Medicaid pays for two of every five babies born in the United States, and three of every five people in long-term care facilities in the US.

Obamacare will add another 20 million new Medicaid dependents. According to the Kasier Family Foundation, that Medicaid expansion will add an average of 13% to state budgets in costs for 2014 alone.

Even though Medicaid was designed to help the poor, studies have consistently shown that Medicaid recipients receive worse medical care than people without any health insurance at all! Medicaid patients have longer waits to see a doctor, fewer specialists to choose from, and poorer medical outcomes overall. A particularly morbid piece of evidence is that on average, Medicaid patients die sooner after surgery than people who have no medical insurance.

Essentially, Obamacare is forcing 20 million more Americans into second-class medical care with Medicaid.

2. "Sticker shock" as the reality of higher health insurance premiums hits home.

The majority of Americans, especially those who are young and healthy and therefore have paid low premiums in the past, are seeing their health insurance premiums rise between 50% and 150%. Further, employers are cutting full-time workers back to part-time by reducing employees' hours per week from 40 to 29 or less, to avoid having to provide those employees with expensive, Obamacare-compliant coverage.

The "Affordable Care Act" has become anything but affordable for most people.

3. Large and small employers are cutting health insurance benefits.

Obamacare expands the requirements for what all health insurance policies must cover. So it's no mystery why premiums have risen: Americans now must pay for a host of features, whether they want to or not. For example, in my office, the women employees are all menopausal. Yet Obamacare requires our small-business health insurance policy to cover pregnancy and maternity care! That means our policy costs more.

These higher premiums force employers to pass on the costs to employees (in the form of higher co-pays and deductibles) and/or customers (in the form of higher product costs). 2014 will bring even higher premiums for most individuals and businesses.

To deal with this onslaught of rising costs, businesses have a series of bad options: fire or lay off workers, cut health insurance benefits for everyone in the company, or reduce full-time employees to part-time so they don't qualify for health insurance benefits, as I mentioned above.

Unfortunately, some businesses will be forced into the worst option of all: going out of business.

4. The employer-based health insurance policies that remain will have higher out-of-pocket costs for employees.

Because businesses must pay more to purchase Obamacare-compliant plans, they will require employees to pay higher co-pays and deductibles before coverage begins.

5. Fewer types of health insurance policies can be offered under Obamacare.

Many small-business plans and existing physician networks are being terminated due to the expanded coverage requirements under Obamacare. We just received notice that our own small-business plan is being terminated.

Candidate and then President Obama promised, "You can keep your insurance plan." Nope.

6. Many people cannot keep their doctors.

Candidate Obama promised, "If you like your doctor, you can keep your doctor." But many patients who like their doctors are being forced to find new ones due to changes in physician networks, as well as doctors leaving insurance plans to start fee-for-service or "concierge" practices.

Sadly, when a patient is pushed out of a long-standing relationship with a physician who understands their medical history, medical outcomes often deteriorate. This is especially true for special-needs patients, who often fall between the cracks when doctors are pressured to see 40 or 50 patients a day in five-minute visits.

7. Further destruction of Medicare.

In 2014, Medicare patients will discover several unwanted changes:

  • higher premiums for their supplemental policies
  • fewer types of Medicare supplement policies available
  • more cutbacks in Medicare-covered services
  • longer delays to see doctors, because many doctors are closing their doors to Medicare patients due to the cuts in reimbursements
  • fewer cancer care specialists taking Medicare patients
  • higher costs for hospital-based cancer treatments, as private offices with lower costs are closed due to reimbursement cutbacks
  • fewer hospital-based surgeries being approved because as of October 2012, Obamacare rules incentivize hospitals (i.e., paid more by Medicare) to do fewer surgeries and procedures.
  • Medicare patients who sign the Advance Beneficiary Notice (ABN) agreeing to pay for services Medicare does not cover will find that they now have higher out-of-pocket costs to pay for these non-covered services.
  • Patients over 80 are already finding reduced approvals for certain procedures and medicines. Expect to see more of this age-based rationing as the Medicare cuts increase over the next decade.

8. Loss of ownership of your medical records.

Your doctors, hospitals, and other health professionals are being pressured to adopt electronic medical record systems and send patient information to the federal government's medical database by 2015. If they don't comply, they'll be penalized with reduced payments for services.

This means the government will own your personal, private information, and you have no say in the matter. I consider this a complete loss of your privacy, as well as a violation of the Constitution's 5th Amendment "Takings" clause.

9. More waivers and exemptions for the political elites and Democrat cronies.

The Obama Administration and its political appointee, HHS Secretary Sibelius, have granted over 1,000 waivers and special exemptions to various Democrat donors, political allies, unions, and others. Obama's politically connected friends are the only Americans who won't suffer under Obamacare's onerous regulations, ballooning costs, and 20 new taxes.

10. On January 1, 2014, the Individual Mandate to purchase Obamacare-compliant health insurance goes into effect.

"Mandate" may sound benign, but it carries the force of law. Those who do not comply face another Obamacare tax (as the Supreme Court defined it), though called a "penalty" by Democrats when they forced the healthcare law through Congress on a partisan vote.

At the end of the day, Obamacare shifts a bigger burden onto taxpayers and increases the number of people on the dole. In other words, it pushes the US in the exact opposite direction it needs to go to solve its massive debt problems.

The most serious problems of Obamacare, however, will be felt at the individual level. You're going to wait longer to see a doctor, you're going to pay more for fewer treatment options, and healthcare quality will deteriorate as doctors and hospitals go out of business.

Obamacare seeks to replace the adaptability and efficiency of our free markets with heavy-handed government control and micromanaging by bureaucrats who don't have a clue about what really helps patients. We need the opposite: patient-centered, free-market reforms.

Such programs have been successfully implemented in states like Indiana and businesses like Whole Foods and Safeway. They used health savings accounts and other incentives to empower consumers to make their own medical spending decisions.

It's possible to reform and improve the broken payment system while keeping our excellent medical care and innovative atmosphere that relieves suffering and improves quality of life. Unfortunately, Obamacare is pushing our country in the wrong direction.

Dr. Vliet writes as an independent practicing physician with medical practices in Tucson and Dallas focused on issues of endocrine aging in men and women from puberty to late life. Dr. Vliet is a registered political Independent, and is also medically independent of all health insurance contracts since 1986. Her allegiance is to and for patients. Dr. Vliet is the 2007 Voice of Women Honoree by the Arizona Foundation for Women for her pioneering work on the overlooked hormone connections in women's health, and she is the author of six consumer books on health topics. She has appeared on nationally syndicated radio and TV shows discussing the healthcare law as well as a variety of health topics for women and men.

Dr. Vliet's medical websites are www.herplace.com and www.InternationalHealthStrategiesLtd.com. Follow Dr. Vliet on twitter @healthandcents

Hat tip: Mustang and Jon Berg


  1. HERE is a comprehensive chart of ObamaCare premiums -- without the subsidy, if any, figured in. Worth studying!

  2. This morning, I'm hearing on the news lots of information about "the delay of the individual mandate."

    Not exactly.

    From the Washington Post:

    It's not quite right to describe this as a delay of the individual mandate, or an extension of open enrollment. There will still be a requirement to carry insurance coverage in 2014....


    What the administration is doing today is probably best described as a tweak to the individual mandate: They are allowing anyone who purchases coverage during open enrollment (up through March 31) to not face a tax penalty for those three months they spent uncovered. This is only true for people who buy coverage through the marketplace....

    More information at the above link.

  3. The elephant in the room...

    Health insurance plans offer to those insured approved networks, which provide discounts for certain types of care, but only if the healthcare providers are part of the plan's network.

    Contracts between providers and insuring companies can change with very little notice and severely limit which providers an insured can see and still have health insurance coverage.

  4. This comment has been removed by the author.

  5. It's been clear to ME and it should be to anyone else who is paying attention that the nations biggest threat today are living WASHINGTON D.C. living in the White-house, and in the U.S. Senate,House of Representatives and especially from the United Nations.. Yes Obamacare is a big threat to our pocketbooks and our economy BUT
    Listen to this video, a Navy Seals says it all. And pulls no punches!. It is Absolutely AWESOME and so sad ,but true!!

    Read more at http://www.westernjournalism.com/what-does-it-mean-to-be-an-american-part-1/#8bwD5ZgVGxYFi9z9.99


  6. A post I did back in 2010 regarding Medicaid for those who think things are bad now for most, just the beginning:
    As of October 1, the Arizona Health Care Cost Containment System will no longer pay for liver transplants for patients with Hepatitis C; certain heart and bone marrow transplants; or lung and pancreas transplants.

    The new transplant exclusions took effect Friday as part of broader Medicaid coverage changes mandated by the State of Arizona in response to budgetary pressures. (Arizona’s Fiscal Year 2010 enacted budget directs AHCCCS to eliminate various medical and health services for adults. See page 20 of the bill).

    In addition to eliminating most organ-transplant coverage, Arizona’s Medicaid agency also is eliminating most dental care for adults as well as coverage of podiatrist services; insulin pumps; percussive vests; bone-anchored hearing aids; cochlear implants; orthotics; gastric bypass surgery; certain durable medical equipment; “well” medical checkups; some non-emergency medical transportation; microprocessor-controlled lower limbs and joints; and it is limiting outpatient physical therapy to 15 visits per contract year. (See list)

  7. Replies
    1. Ah. So let me see if I understand. Is this what happens when you vote twice for a community organizer, because he’s black?

  8. It was never about health care, was it? Create another crisis which won't be wasted.

  9. My recommendation would be to BOYCOTT the SYSTEM. Don't even TRY to use it. SHUN it. REFUSE to participate. If the vast majority (we'll never get all) would do this the God-damned thing would did aborning. Just DON’T play their rotten game. DON'T get euchred. DON'T get snookered. The best place for you -- and me -- and all of us is UNDERGROUND.

    Better for us to die young of untreated symptoms than to live as slaves to The Oligarchs. Deny THEM absolutely EVERYTHING, even if it costs you your life.
    The New American Revolution, if it is to happen at all, will have to be fought with PASSIVE RESISTANCE.

    Don't wait till you are so fed up, so frustrated and so filled with hatred and contempt that you become paralyzed.






    Go ahead and LET them RUIN your life
    Our lives will be ruined ANYWAY –– especially if we don't call a halt to the madness. NOW.


    GET OFF the GRID.


  10. Obamacare will be a resounding success and just like medicare and social security, the right is on the wrong side of history once again.

    1. Agreed. I actually LOLed at the blatant and ridiculous falsehoods a couple of times reading the article above. LOLed reading FreeThinke's comment too... especially the part about being slaves to the oligarchs. Isn't that something that is, in a Conservative's mind, desirable?

  11. George Will today asked this question (paraphrasing): suppose the 30-somethings decide to forego the incompetence of the website registration, and only those who need medical care (because they are sick) sign up. What is the likely impact on Commie Care then?

    1. Mustang,
      The same impact that would result if many insured drivers were high risk, yet the rates for the safe drivers were the same as the rates for high-risk drivers.. Overall rates would rise sharply, and the safe drivers would be subsidizing the high risk drivers.

      General principal behind most insurance: insurance premiums are affordable only when low-risk insureds are in the same pool.

      Now, if one carries insurance of any kind for years (decades) as a low-risk insured, then the rates can remain relatively stable when one age, and insurance payments have to be distributed.

      What will not allow insurance to work in the sense of affordable premiums is a pool with a multitude of high-risk insureds.

      This is not rocket science. It's easy to understand.

    2. Um, "principle," not "principal." Sheesh.

  12. The people who were in charge of the website are inept. There is no excuse since they were using our money for over 3 years to put everything together.

    Medicare and social security are only a success if you believe more people should be dependent on the government and if the person doesn't understand basic economics.

  13. I have this sinking feeling in the pit of my stomach that Obama know all the time the truth and that the whole program will NOT work. and that he knew more than wéll ever know. You would have to be pretty naive to think that any of those contractors would admit that they designed and installed an incompetent ObamaCare web site without Obama’s final testing of it. As for Sebelius trying to tell us that Obama didn’t know anything about it! It’s her job to protect him, But after hearing his this embarrassment in trying to shift the blame on this entire ObamaCare program, makes me Ashamed to be a Democrats. This woman fell on her sword last night for Obama stating he was unaware of any technical problems with the HeathCare.gov website to enroll in. Now she admits she will not participate in Obamacare. I'm getting tired of hearing the same stupid shifting of blame shit. The exchange was set up for those who don't have insurance. This stupid song and dance is getting to be more than silly, it’s an embarrassment!

    And It’s an embarrassment watching people in my own party and on the blog I follow try to make excused for it, Right *Progressive Eruptions!*?

  14. It's becoming increasingly obvious that the ACA website was deliberately designed to fail so that we are FORCED to go into "Universal Healthcare" meaning all of us pay through the GOVERNMENT for our OWN care AND everyone else's. That will mean HUGE increases in our individual tax burdens, less disposable income for all but the super rich and a degraded levels of care for everybody.

    Welcome to Europe -- without the unique charm, historic architecture, irreplaceable art treasures, distinguished, varied types of cuisine, and rich multi-lingual heritage.

    Welcome to The Union of Socialist States of Generica.

    We'll all be EQUAL -- equally mediocre, equally without hope for advancement or upward mobility. A land without privilege, without favor, without distinction, without history, without an authentic culture. A land from which you have no hope of escape, because there will no longer be any new horizons. You will simply be GIVEN whatever the government thinks you NEED -- no more -- no less. You will no longer be burdened by having to make choices. Everything will be decided FOR you by Superior Minds who benevolently direct your path from Womb to Tomb, and decide FOR you when it is time for you to DIE.

    Won't it be lovely?

  15. This comment has been removed by a blog administrator.

  16. There is a Sicko Moron Liberal left-wing socialist Douchebag who comments of SHAW’S blog that Mocks, and Mimics, and ridicules the posters on AOW’s and on GeeeeeZ’s blogs with his or her’s stupid impressions of the Conservative posters here.

    I can understand the stupidity impressionist, as there is no limit to the idiocy and the utter foolishness from these lost souls, but what gets me is the lack of intelligence and the poor decision of SHAW to not only allow it but she seems to encourage it by not deleting any of it, as it’s been going on for weeks upon weeks. Or maybe I am expecting to much of her..

  17. Thanks Just Joanna, I just saw what you mean..
    I always knew that progressive/liberals had to be good at something

  18. Another you can add to this fine article:

    Many patients won't be able to see an actual doctor any more. Instead they will be shuffled to Nurse Practitioners, who have very little training and even less experience in diagnosing medical problems and in how to treat them.

    Many doctors are retiring early, and I haven't checked the numbers, but there may be fewer doctors actually going into practice in the future. Mistakes will be made and patients will suffer.

    My hubby's last day in the ER is next Thursday.

    Right Truth

    1. Debbie,
      Thank you for adding that important information!

  19. If all this was was a crappy web site it would be a short lived story. But once people actually get through and find out how much more they will pay and what little they will get they are going to be really mad.

    Note to libs: Don't say we didn't warn you.

  20. Right wingers, what is your answer to combat the political momentum you are facing? Demographics are going against you. The coming generation's upbringing of sharing and being unselfish is going to hit mainstream soon. Society is war weary, and sees the GOP as being at fault for it. Gay marriage is a losing issue for the right. So is abortion.

    The snowball effect is kicking in now. You have Bill O'Reilly losing his temper, and Sarah Palin stumping for another loser. You have a SC Republican saying "Its good politics to oppose the black guy in the White House" (seriously, thats what he said).

    You have the housing and job market creeping into a better state. You have Wall Street hitting record highs. You have the deficit starting to show signs of stability. You have the 2 wars coming to an end. You have the Tea Party looking more looney by the week.

    Is the right wing about to become nothing more than a fringe alternative lifestyle? Yes it is, the primary qualifications for being a nutball today are limited intellect combined with stunted emotions. Like the materially poor, mental deflects will always be with us but thanks to modern chemicals this group seems likely to continue to shrink in numbers and pestilence. But continue with your fantasy. I'm sure you find comfort in it. Perhaps a Ted Cruz candidacy might give you some hope.. I’m sure that the Teabaggers/Birthers/Republicans will have no trouble finding Cruz eligible to be President. after all, he's not black, and he’s great at reciting Dr. Seuss.

    1. "he’s great at reciting Dr. Seuss."

      It is quite posssible that Ted Cruz knows that the USA does not have 57 states, and that a Navy Corpsman is not a dead man walking. Sure, both Obama and Cruz are products of Harvard. So what?

      We desperately need political leadership that is smarter than Barack Obama. Most people recognize that Barack baby is incompetent in the areas of economics, foreign relations, and any kind of management.

      We will live through the incompetent little bastard, and it will take us a couple of decades to clean up after him and his crew. Even people like Shaw will curse the day they ever heard of Barack Obama. He is that bad, and he is doing a predictable job of showing the world just how incompetent a US President can be.


  21. Shaw Keewee, you are wet behind the ears, and perhaps somewhere else as well. First of all, his mother was an American citizen.
    So please stop getting caught neck deep in horse manure. There are needs that this country cannot wait to remedy after this catastrophic presidency. Cruz being born in Canada would be no problem for Birthers, after all Cruz is half Cuban / half white, - while Obama is one third black / one third white / and one third Kenyan.

    Besides, the idea that opposition to Obama is only about racism is just a very poor attempt to disparage people who feel that he his completely out of the league of people who can really LEAD.

    For example lets take the day that he spoke at the UN. even the asswipe leader of Iran told him off. They know he is a weak kneed little sissy. He’s all about talk and he has no substance and the rest of the world’s Leaders do not respect him.

    Cruz has never been a Muslim sympathizer, he believes in America's founding principles, and doesn't hate America. While Obama made history as the first black president he also made a lot of promises for our country. Promises that he didn't keep. Do I need to elaborate? I think not.

  22. I don't really give a shit about this Mumbo Jumbo, all I really care about is the deficit, defense and the safety of our troops. whoever gives me that gets my vote... On that note I think I'll go buy another gun today, eat some donuts, and have a 20 once sugary drink

    I can't wait till the next election is over...so people like Shaw Keewee can climb back under their rocks.

  23. No matter what we say, here, we are stuck with Obama Care. We all knew that with this law everybody would get higher healthcare costs, less healthcare, and lower quality. It has been obvious for a long time that the goal is to get everybody down to a least common denominator of care, i.e., like the useless system the UK has. It will be Medicaid for everybody, and everybody will pay huge amounts.

    More people will die early. More women will have problems getting pre-natal care. Senior citizens will face the Obama death panels as doctors leave Medicare practice, and hospitals start refusing to treat old people. It will be like in the UK where if a person is over 74 yrs old, they are not even a statistic.

    This is what socialized medicine brings. Black people get the shaft from a black President. Hispanics will get it, too, except for illegal aliens who will get healthcare for free (wait for immigration "reform"). Demographics will make no difference because socialism is slavery to everyone in the system. Only fools think otherwise.

    1. Bob,
      You bring up this point:

      No matter what we say, here, we are stuck with Obama Care.

      We are stuck with more than that.

      But, yes, all our outrage and objections are pointless.

      American apathy has overcome good sense.


      The other day, I was explaining to a few friends what the severing of Kaiser and Inova Health meant for patients. Kaiser provides health insurance for over 500,000 people in the D.C. area, and Inova Health is the largest medical provider. Now, all those patients will be able to use only 4 hospitals. FOUR!

      I got these responses:

      (1) I don't have Kaiser, so I'm okay.

      (2) My policy is still in force, so my kid can get such and such care.

      (3) You don't have Kaiser, do you? So, your eye surgeries next year will be covered, right? [meaning, you'll still be able to teach my kids next year, won't you?]

      In other words, if it doesn't touch you or me, then we won't worry about it.

      I am reminded of "First they came for the Jews..."


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