Sections 1311 and 1322 of the Patient Protection and Affordable Care Act authorizes Federal subsidies to State run insurance exchanges. But due to a "massive legislative defect" created by sloppy Democrat bill writers working in haste to force this odious legislation upon America, there is NO provision for the Federal government to make essential subsidy payments to Federally established exchanges. In the absence of a State insurance exchange and with NO CONGRESSIONAL AUTHORIZATION to fund Federal exchanges, any State that REFUSES to form an exchange will effectually ensure that within its State boundaries, ObamaCare cannot be implemented!
Here's why: ObamaCare offers "premium assistance" – tax credits and Federal taxpayer dollar subsidies – to households purchasing coverage through new State health insurance exchanges. Democrats knew this assistance was essential to hide much of the law's cost and reduce the vast premium hikes Americans will face after ObamaCare goes into effect in 2014. If consumers had to directly absorb the full cost of nationalizing one sixth of our economy, the already strong support for repeal would skyrocket!
So ObamaCare authorizes premium assistance in State-run exchanges (Section 1311) but in a glaring failure, not Federal ones (Section 1321). In other words, a State refusal to create an exchange will act as a clear mechanism to block much of ObamaCare's spending and paralyze implementation of the law.
The problem is, many States think they are going to get a pot of federal gold to fund these "State exchanges" and help take enrollees off their Medicare rosters. Guess what? Just the opposite! Cost estimates are skyrocketing, there's NO MONEY (just deficit spending): they are (surprise, surprise) already running BILLIONS and BILLIONS over budget in Obama Funny Money!
In a recent budget hearing, the Republican chairman of the U.S. House tax-writing committee questioned why Obama administration spending estimates for State insurance subsidies for the exchanges were up by $111 billion from a year ago.
Obama's fiscal 2013 budget request, released Feb. 13, projected that subsidies for low-income and working-class people to buy individual policies through the State exchanges would total $478 billion through 2021. But the administration pegged the cost at $367 billion over the same period in its fiscal 2012 budget proposal.
Kathleen Sebelius of HHS could not explain the huge increase, saying the estimate appears in the Treasury Department's budget. According to Congressional experts, the increase "cannot be explained by legislative changes or new economic assumptions, and therefore must reflect substantial changes in underlying assumptions" about the way the subsidies would work. Or is that NOT work?
Ranking members on both sides of the aisle queried whether the Obama administration believes insurance premiums would be more expensive than Treasury's earlier predictions, or if more workers would lose coverage through their employers than expected.
Medicaid systems, meanwhile, are in disarray. The exchange subsidies and Medicaid are related because people who seek insurance through the exchanges will be automatically enrolled in Medicaid if they earn poverty-level wages or are unemployed. Welcome to the ObamaCare fast track to universal coverage / single payer / 100% government run socialist healthcare!
Changes Congress has made to the healthcare law since it was enacted in 2010 were supposed to militate against this pressure, and contain Medicaid enrollment and costs. But Kentucky, New Hampshire, Kansas and Louisiana have moved aggressively toward mandatory managed care during the past six months in order to address rapidly expanding state Medicaid budget burdens. Other states, including Florida and Georgia, are poised to move quickly down the same path. These dramatic policy shifts in the name of "integration" and cost savings are already causing major controversy and public outcry, provider and service disruptions, and reductions in quality of care. THERE IS NO TIME TO WASTE! YOU NEED TO TELL THE STATES – STOP OBAMACARE COLD!