“The Patient Protection and Affordable Care Act (PPACA) is not so much a set of norms to regulate conduct as an authorization to administrators to produce norms to regulate conduct. Implementation of the Act will require many years and literally thousands of administrative regulations that will determine its substantive content and coverage. Under current law, those regulations will be promulgated through so-called informal rulemaking procedures, which offer very limited opportunities for public input.”

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“Even with ObamaCare set to inflate the Medicaid rolls, reimbursement rates are falling further. When the NBER investigated Oregon’s program, the state paid doctors 90% of Medicare rates — more than most other states. But since then, Oregon, as well as nearly half its peers, has cut payments. More doctors will doubtless leave the program as a result. This supply problem is one reason the NBER study specifically cautioned against extrapolating its results to model ObamaCare’s expansion of Medicaid. Under ObamaCare, one in four Americans will be covered by Medicaid at a total cost of nearly a trillion dollars. They may receive subpar care — or may not even be able to get an appointment with a doctor. But as the NBER report shows, at least they’ll have a ‘general sense of improved well-being.'”

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“Twenty (20) percent of small employers currently offering expect to significantly change their benefit package and/
or their employees’ premium cost-share the next time they renew their health insurance plans. Almost all significant
changes expected involve a decrease in benefits, an increase in employee cost-share, or both. Since enactment, one in eight (12%) small employers have either had their health insurance plans terminated or been told that their plan would not be available in the future. Plan elimination is the first major consequence of PPACA that small-business owners likely feel.”

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“The survey, released by the National Federation of Independent Business (NFIB), found that small businesses don’t have much faith in the new law’s power to control healthcare costs, but they don’t necessarily expect to quit offering coverage as a result… And employers reported a starkly negative opinion of the new law. At least 75 percent said they expect to see their taxes rise and don’t believe the new law will control the cost of insurance or reduce their paperwork burdens.”

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“Obamacare thwarts potential hiring in three ways, as the Heritage study points out. The law excludes firms with fewer than 50 employees from its mandates, so companies aren’t going to expand and hire if it means exceeding that cap. Companies that employ more than 50 workers already will see their costs rise as they must provide insurance that meets the government-defined minimum requirements or pay a penalty. The biggest problem of all, of course, is the uncertainty Obamacare creates.”

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“For a while, backers of last year’s health care overhaul have argued that it will become more popular as more people are exposed to its benefits. In particular, they’ve hoped that the supposed consumer protections that were front-loaded into the law’s implementation schedule would bolster the law’s sagging popularity. It hasn’t happened. A new poll by the Kaiser Family Foundation suggests one reason why that might be the case: ‘Only 20 percent of people believe consumer protections will get better under the law, while most others think protections will stay the same or get worse.'”

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“One proposed departmental rule deals with what may become a centralized database containing patient medical records and pharmaceutical claim information. It’s an extremely technical issue but Section 153.340 of a new HHS proposed rule dealing with Obamacare mandates that individual states (or the department) collect ‘raw claims data sets’ from all insurers on all people with private coverage purchased either individually or through small employers, which includes that obtained from the new state exchanges the law requires be created.”

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“In a truly market-based insurance exchange, women would be able to choose a health plan that met their needs and was consistent with their values, and those who wished to forgo certain benefits would have the freedom to do so. If any attempt at health reform is to succeed at reducing costs and tailoring coverage to the specific needs of each individual, it must ensure that consumers are able to choose the plan and benefits that work best for them, rather than submitting to the decisions of a bureaucratic board.”

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“President Obama says that his health plan’s popularity will grow once its provisions start being implemented. But peculiar rules tucked into the legislation are likely to make the entire scheme even more disliked as its implementation approaches… The problem is that the actual insurance that health plans offer may be fairly lousy — perhaps just a little better than the typical managed care plan offered under Medicaid. That’s because of the way these insurance products are going to be regulated, and the way they will be priced under the federal scheme.”

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“In our most dynamic case, when all covered employees are compensated in higher wages to offset their payment
of the full ESI premium in order that some will be able to take full advantage of an affordable coverage rule that
is broadly interpreted to mean affordable family coverage, we estimate that the movement of workers out of ESI
and into exchange-based coverage will: 1) overwhelm the number of workers moving into ESI by currently
uninsured workers in large firms due to the mandates; 2) cause the provision of health care insurance to working
Americans to become more sharply segregated based on family income; and 3) cost taxpayers up to $5 billion
dollars in gross subsidies for every one million workers who switch from being an ESI main policy holder to
receiving subsidized exchange coverage, all else equal.

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