"CMS’s effort, launched by Obamacare, to use the leverage of Medicare reimbursement to impose and control a favored model of health care delivery is bound to fail, but only after increasing the angst of providers and patients and dissipating large amounts of resources—money, time, and brainpower. It blocks the development of other ideas for reforming health care delivery. However, changes in the proposed regulations to fix the anomalies and problems discussed above, and numerous other provisions like them not discussed here, would not be sufficient to rescue the scheme. The Shared Savings Program and its ACOs are fatally flawed by the overweening assumptions embedded in the PPACA itself."

"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."

"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.

"The Independent Payment Advisory Board (IPAB) was created based on the premise that decisions about the pricing of health benefits offered by Medicare are simply too contentious to be adequately handled by our present political system. But these decisions are precisely the kinds of consequential choices that should be subject to close public scrutiny and an open, rigorous, and transparent decision-making process that engages with Medicare's stakeholders. Changes to the way Medicare pays for and covers medical services affect too many people in significant ways to be made behind the closed doors of an insulated committee."