Nine Obamacare takeover elements at stake in King v. Burwell

As the Supreme Court considers oral arguments in the King v. Burwell Obamacare subsidy case, the media is awash in claims that a King win will be a political disaster, forcing Republicans to save the illegal Obamacare subsidies issued in the 37 states without a state-based exchange. But the real disaster is the Affordable Care Act (ACA) and the dangers the federal takeover of healthcare poses for patients, doctors, pocketbooks and health freedom. 

These very real dangers include: 

Socializing Medicine – The ACA sets up Accountable Care Organizations (ACOs) to nationalize the delivery of medical care. ACOs, sometimes called “HMOs on steroids,” meld physicians and hospitals into a single unit. Under annual capped government payments to ACOs for the care of “populations,” physicians and hospitals essentially become “insurers,” at risk for the cost of care – and patients become financial threats to the ACO’s bottom line. 

Federalizing Coverage – Obamacare’s national Exchange system was established to eliminate private insurance and expand government coverage. Everyone seeking coverage on an Exchange applies to the federal government for coverage. If the ACA is not repealed, the national Exchange system will become the nation’s only source of coverage. 

Expanding Dependency – After outlawing many affordable private health insurance policies, Obamacare increased the cost of coverage and forced many Americans onto the government Exchange to get less affordable coverage limited and subsidized by the government. 

Ending Employer-Based Insurance – Beginning in 2018, premium costs that exceed $10,200 for individuals and $27,500 for families will be taxed at 40 percent. The thresholds for this ACA “Cadillac Tax” are indexed, capturing more employers each year and eliminating the tax advantage of employer-sponsored insurance. Over time, employers will drop coverage and employees will be forced into the Exchange and into Obamacare. 

Caring for the Healthy, Not the Sick – The ACA focuses on prevention and “populations,” not patients. This switch changes how doctors are paid and patients are viewed. David B. Nash, M.D., dean of the Jefferson School of Population Health in Philadelphia told that population health “realigns the incentives for the health system to care about health instead of sickness.” He calls it a “completely different focus.” Indeed. This focus means fewer dollars to care for actual patients. 

Implementing a Massive Redistribution Scheme – Under the Obamacare Risk Adjustment program, premium dollars from health plans with lower-risk populations are sent to health plans with higher-risk populations. The most data-savvy health plans will profit mightily by making their enrollees’ “individualized risk scores” look the worst. 

Paying Physicians for “Value” – Electronic reporting requirements, Obama’s 2009 mandate for interoperable electronic health records (EHRs) and the ACA’s “value-based purchasing” initiative will end physician autonomy. Doctors will be increasingly paid for “value,” not for actual services given. “Value” is determined by outsiders analyzing EHR patient data and may mean complying with one-size-fits-all treatment protocols or agreeing to participate in ethically-challenged “team-based care.” 

Replacing Physicians With Teams – The ACA creates incentives for “team-based care” in “medical homes.” The Annals of Family Medicine claims a shortage of primary care doctors “requires the replacement of physician-only care with team-based care.” It suggests creating “standing orders that empower nonclinicians to share the care.” Thus, clinic staff would follow computer-based treatment protocols leaving patients at the mercy of non-physicians — and in the dark about who’s actually responsible for their care. 

Ending Insurance – The ACA eliminated health insurance, outlawing catastrophic coverage for most people and mandating that health plans cover people with pre-existing conditions. This is not health insurance. Insurance protects against the financial threat of chronic, serious or life-threatening conditions the enrollee does not yet have. But the ACA forces health plans to cover people with these medical conditions at no extra cost to these individuals. Thus, the ACA replaces insurance with mandatory third-party financing of medical expenses and higher premiums for all. 

King vs. Burwell could shut down Obamacare. If King wins, Republicans should not try to save the subsidies. They should herald the win as a mighty strike against the federal takeover of health care, and they should loudly proclaim that millions of employers and individuals in 37 states have been justly saved from Obamacare’s onerous mandates and penalties. Short of a repeal, this is the best ‘save’ of all. 

Brase is president and co-founder of Citizens’ Council for Health Freedom, a patient-centered national health freedom organization based in St. Paul, Minn., that exists to protect healthcare choices and patient privacy.​

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