“Okay, I admit it. I am completely baffled. Maybe one of you smart folks can help me out here. I am reading a new Kaiser Family Foundation issue brief on “Implementing New Private Health Insurance Market Rules,” and scratching my head.”

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“A major criticism of the Affordable Care Act (ACA) is its attempt to impose “one size fits all” health policy on states with
different populations and markets. Whereas health insurance was historically regulated by the states, the ACA and
accompanying regulation imposes numerous new rules onto health insurers and employer-provided plans. Millions of
Americans will be eligible for subsidized health insurance coverage in 2014, and supposedly able to enroll in said
coverage by October.”

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“Months since the Supreme Court ruling that made the Obamacare Medicaid expansion optional, the state costs associated with expansion still remain highly uncertain—making expansion a dicey course for states and their budgets.
Indeed, states should not lose sight of the fact that the original Medicaid expansion was coercive for a reason.”

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“Unfortunately, Obama is pushing the code in the opposite direction. Not only has he managed to get rates increased as part of his “fiscal cliff” deal, his health reform law will add vast new layers of tax complexity. For example, ObamaCare adds a new refundable tax credit to offset the cost of insurance that will not only be a nightmare to administer, but will also narrow the tax base still further by kicking 8 million off the tax rolls. The law gums up the code with new breaks for small businesses, health care investments, adoptions and so on. And it forces the IRS to figure out who gets penalized for not buying insurance and how much they owe.”

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“Health-insurance premiums have been rising—and consumers will experience another series of price shocks later this year when some see their premiums skyrocket thanks to the Affordable Care Act, aka ObamaCare. The reason: The congressional Democrats who crafted the legislation ignored virtually every actuarial principle governing rational insurance pricing. Premiums will soon reflect that disregard—indeed, premiums are already reflecting it.”

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“But the company now faces a new problem because of the Obama health law. Automation Systems Inc. has expanded to include 37 employees today, and Schanstra says he wants to hire more — maybe as many as 200 or 300 in the next 10 to 15 years. But once the business crosses the 50-employee threshold, it will have to pay $40,000 in penalties, plus $2,000 for each additional employee. That’s because of the so-called employer mandate, a fee imposed on businesses that get too big without providing health care the federal government deems acceptable.”

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“Can’t get enough of Obamacare’s individual mandate? Get ready for ‘mandate plus.’ … They want more incentives — such as a late enrollment fee — to get healthy people to sign up quickly… The states could impose some of these incentives, too, and they could become a future lobbying battleground. But right now, the insurers are focused on persuading the Department of Health and Human Services to add them on its own.”

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“If you work for a small business, your next health insurance premium may give you sticker shock. Many of the small-business and individual insurance policies are working the health reform law’s 2014 fees into their 2013 bills, contributing to double-digit premium increases for some people. All those new consumer benefits packed into the health reform law — birth control without a co-pay, free preventive care and limits on when insurers can turn down a customer — had to be paid for somehow.”

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“The answer is that replacing Obamacare is by necessity a long-term project; you have to start somewhere. Moreover, it remains essential. Like it not, health-care policy is central to the struggle over the size and scope of governmental power. Without a better approach than Obamacare, there will be no success in limiting government or in lessening the dependence of citizens on the state.”

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“Thus, as it now stands, only 14 to 16 states (plus the District of Columbia) are likely to actually be operating state-run exchanges come October, when open season begins. There may be another two or three states with so-called partnership exchanges, but the feds will be responsible for most of the major functions in those states. Indeed, the final count could be lower as some states trying to set up their own exchanges—faced with significant technical challenges and limited remaining time—give up and default to a federally run exchange.”

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