“While the individual mandate tax gets most of the attention, the ObamaCare law actually contains 20 new or higher taxes on the American people. These taxes are gradually phased in over the years 2010 (with its 10 percent “tanning tax”) to 2018 (when the tax on comprehensive health insurance plans kicks in.) Six months from now, in January 2013, five major ObamaCare taxes will come into force.”

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“So, by refusing to go along with Obamacare’s Medicaid expansion and by blocking state-run exchanges, governors are not just saving state taxpayers money. They are potentially reducing future federal spending by as much as $1.5 trillion over the next ten years. While congressional Republicans have been reduced to taking symbolic repeal votes, and Mitt Romney struggles to determine whether or not the individual mandate is a tax, governors — and state legislators — have become the real heroes of the fight against Obamacare.”

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“Americans are more likely to say the 2010 healthcare law upheld by the Supreme Court last week will hurt the national economy (46%) rather than help it (37%), while 18% say they don’t know or that it will have no effect.”

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“ObamaCare has been a war over the processing of insurance claims. It has been fought by institutional interests representing insurance, hospital and pharmaceutical firms. The doctor-patient relationship, or what used to be called ‘the practice of medicine,’ has sunk beneath these waves.”

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“Much attention has been given to the argument that without the individual purchase mandate, other parts of the health care law would become unworkable. Much less attention has been given to the fact that without the states forced to be on board with the Medicaid expansion, the law’s health exchange subsidies might be fiscally unworkable. The Supreme Court may have just set in motion of chain of events that could lead to the law’s being found as busting the budget, even under the highly favorable scoring methods used last time.”

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“The Supreme Court has spoken, but problems built into the Affordable Care Act (ACA) have not been resolved by the decision and may have worsened. Even accepting the law’s assumptions about how the health system should be reformed, actually putting all the pieces in place is exceptionally expensive and difficult. If President Obama wins a second term, fiscal pressures and practical challenges will force him to scale back the unaffordable spending and slow down the unrealistic implementation timeline.”

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“Reconciliation allows a bill to pass the Senate in a limited time period, with limited amendments, and with only 51 votes; filibusters are not permitted. In 2010, Democrats split their health-policy changes into two bills, one of which they enacted through this fast-track process. In 2013, a Republican majority could use the same reconciliation process to repeal those changes.”

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“With Thursday’s Supreme Court ruling upholding President Obama’s landmark health-care law, debate has shifted to whether deadlines key to the law’s goal of expanding coverage to tens of millions of Americans will be pushed back. Some say states and the federal government are facing such complex technical and political realities that some deadlines need to be relaxed, including the Jan. 1, 2014, opening of online marketplaces where individuals and small businesses will be able to shop for coverage. And there may be pressure in Congress to delay some spending on the law to help reduce the federal budget deficit.”

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“When the Supreme Court upheld the Affordable Care Act in a 5-4 ruling Thursday, the American Medical Association was quick to release a statement in support of the ‘historic’ decision that will give more people access to health coverage.
But (and there’s always a ‘but’) medical professionals across the country are wondering: When an additional 32 million Americans get medical insurance, who exactly is going to treat them?”

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“The Roberts court declared this threat unconstitutional, finding that Washington could use the carrot (dangling new money) but not the stick (withdrawing old money). The states, when they initially signed up for Medicaid, could not have anticipated that Congress would one day enact a law that caused Medicaid to be ‘no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage,’ the Court reasoned.”

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