The Independent Payment Advisory Board (IPAB), an unelected group of fifteen officials, has been given the power to determine payments for healthcare services in Medicare if spending exceeds target levels in the law. Patients will have no recourse with their members of Congress. The result will be less access and worse service for America’s seniors - a growing problem that will be accelerated greatly. Additionally, by blocking the actions and authority of future Congresses, a lawsuit is no moving forward on this provision’s constitutionality.

The Obama Administration also implemented controversial rules mandating all employers, with few exceptions, provide coverage that many claim violates their first amendment rights of religious freedom. In spite of the media firestorm and spin, the courts have already begun to strike down this provision.
Even the touted policy provisions in the health care law that have been implemented to date have been a failure. The vaunted high risk pools have missed their enrollment claims by nearly 90%, while simultaneously incurring per patient costs of twice what was estimated. The limits on pre-existing conditions for child only health insurance policies, while a nice soundbite for television, have resulted in the near elimination of these policies in a significant majority of states—leaving parents with fewer, and often more expensive choices.

Studies are also showing, as was anticipated, that allowing adult children up to age 26 to stay on their parents insurance is raising insurance rates up to 3% per year. In yet another generational power and money grab, this is increasing insurance costs up to $450 already for younger working families.
Low-income, minority, inner city families have also seen their choices and quality diminish at an ever increasing rate. As I wrote in The Hill just after the law’s passage, cuts to hospitals and providers that disproportionately treat the poor, will result in care becoming less accessible. 43 states have moved to cut payments for services under Medicaid. Fewer than half of all physicians are seeing new Medicaid patients. Cuts to covered services and medications are progressively turning Medicaid into third tier health care- a trend that will accelerate with the over $70 billion states will additionally have to fund in the next ten years alone to comply with the law.

Medicare Advantage, the flawed, but functioning private component of Medicare that has over 10 million seniors enrolled, with poor and minority seniors as its biggest users, is gutted under the law. To keep the program propped up until after the election, the GAO has found, in the words of the New York Times, that the Obama administration is wasting $8 billion to reward providers of mediocre care.

The politics here should worry the president and Democrats. The Kaiser poll just released shows that the groups currently supportive of the law but most apt to change their mind are younger voters and minorities.

Health insurance exchanges are the next impending boondoggle. The CBO just last week released estimates that $1 trillion in direct subsidies to big insurance companies by 2022. The real number for 10 years of subsidies, due to phased implementation, could easily be twice that. The country cannot afford even this number—and, as many liberal commentators have noted, out of pocket costs for American families will continue to skyrocket.

American families continue to believe the law will make health care worse for themselves and the country. Rasmussen numbers show that desire for repeal is effectively the same now as it was just after passage and just before the 2010 midterm elections.

To paraphrase Nancy Pelosi, the more Americans learn about what is in the law, the less likely they will be to support it. The insurance rebates do not apply to self-insured companies- accounting for over 100 million insured Americans- 60% of the entire commercial market. The other rebates come directly to business owners and not to employees. The moral imperative of an essential health benefit package, as Senator Jon Kyl (R-Ariz.) and I noted in a recent oped, also does not apply to these same families, and the packages will continue to vary significantly by state.

The winners with the ACA are groups with the lobbying power to help shape the tens of thousands of pages of regulations that the law will spawn, and the bureaucrats that write them.  Solutions to make health care more affordable and accessible to the 70% of Americans who rarely use the system, and ways to more effectively manage the 5% who spend 50% of all health care dollars, will require a new approach to health care reform—one that puts health care decisions in the hands of patients and families, not politicians and their pals.

Dr. Novack is an orthopaedic surgeon in Phoenix, Arizona.