Even Supporters Fear Obamacare’s Impact on States

An eye-opening article in yesterday’s Los Angeles Times shows the dilemma states are facing as they begin to make crucial policy and budgetary choices surrounding Obamacare.  The article notes that the law “takes states into uncharted territory” as they attempt to estimate the fiscal impact of Obamacare’s massive Medicaid expansion:

California, which plans to expand coverage to hundreds of thousands of people when the law takes effect in 2014, faces myriad unknowns.  The Brown administration will try to estimate the cost of vastly more health coverage in the budget plan it unveils next month, but experts warn that its numbers could be way off.  Officials don’t know exactly how many Californians will sign up for Medi-Cal, the public health insurance program for the poor.  Computing the cost of care for each of them is also guesswork.  And California is waiting for key rulings from federal regulators that could have a major effect on the final price tag, perhaps in the hundreds of millions of dollars….

Unanticipated costs associated with the healthcare changes could undermine California’s efforts to improve its standing on Wall Street and keep the economy moving.  They could force fresh cuts in services if they consume much more of the state budget than Brown is able to approximate….

Gov. Jerry Brown expressed a new concern in an interview last week.  He said recent signs from Washington suggest the federal government may not pay as much of the costs associated with the new law as originally promised, sticking states with a larger share of the bill.  “As the guardian of the public purse here, I have to watch very closely what may come out of Washington,” the governor said.  “So we’re going to move carefully.  We want to make sure the federal government is on board.”

These statements of caution and concern come from a major supporter of the law.  And little wonder: Over the past two fiscal years, states had to close a combined $146.3 billion in budget gaps – yet Obamacare is about to impose new unfunded mandates on states of at least $118 billion.  Both the numbers, and the diffident attitude from the governor of the largest state in the union, should serve as a cautionary tale for states contemplating the massive fiscal hit Obamacare will impose on their budgets.

Obamacare’s Fiscal Damage Comes Out of the Woodwork

Following last week’s release of CBO’s re-estimate of the health law in light of the Supreme Court’s ruling, it’s worth digging into the new numbers a bit more to examine the Congressional Budget Office’s assumptions, one of which is the “woodwork effect.”  “Woodworking” refers to uninsured individuals who were already eligible for Medicaid, but who will now come “out of the woodwork” and finally apply for benefits – due to the individual mandate, publicity surrounding the law, new efforts to streamline enrollment processes, etc.  Last week CBO revealed for the first time its belief that the “woodwork effect” will comprise more than one million more individuals, and a greater percentage of the newly enrolled, than the Medicare actuary had previously asserted.

In its updated analysis, CBO assumes that due to the Court ruling, “about one-fifth of the people who would have been eligible for Medicaid in the absence of the [law] and were, in prior estimates, projected to enroll will no longer enroll in Medicaid.”  Elsewhere in the same report, CBO concludes that these individuals – those who would have been attributed to the “woodwork effect,” but will now not enroll due to the Court ruling – comprise about one-quarter of “the 6 million people who will not have Medicaid coverage in 2022 as a result of the Court’s decision.”  These numbers allow for some simple extrapolations:

  • CBO assumes the Court ruling will reduce the “woodwork effect” by 1.5 million individuals (6 million times one-quarter);
  • CBO originally assumed the “woodwork effect” would result in 7.5 million previously eligible individuals enrolling in Medicaid (1.5 million divided by one-fifth), but now believes the effect will result in 6 million previously eligible individuals joining Medicaid in light of the Court’s ruling (7.5 million minus 1.5 million); and
  • In their March 2012 analysis prior to the Court ruling, CBO assumed that the newly eligible would constitute at least 9.5 million enrollees – 17 million total newly enrolled in Medicaid, minus 7.5 million already eligible for Medicaid but new-to-enroll thanks to the law.  (The “at least 9.5 million” designation reflects the fact that some states who had previously expanded their Medicaid population above 138 percent of poverty may now shrink their programs to be consistent with the new federal guidelines, causing some individuals currently eligible for Medicaid to lose coverage.)

Conversely, the Medicare actuary has predicted a much smaller “woodwork effect.”  In his annual Medicaid actuarial report in March, he claimed that of his estimate of 25.9 million new Medicaid enrollees in 2022, “82 percent are projected to be newly eligible (that is, eligible only under the new rules beginning in 2014), while 18 percent are projected to be eligible under the current Medicaid rules.  This latter group is expected to enroll in Medicaid as a result of the new assistance that will be available through the simplified enrollment process, the health insurance exchanges, and the publicity associated with the expansion of eligibility.”  This means that the Medicare actuary estimated a total “woodwork effect” of 4.7 million enrollees (25.9 million times 18 percent) – several million beneficiaries less than CBO’s initial 7.5 million estimate.  It also means that the actuary estimated that of the 25.9 million total new enrollees, 21.2 million (25.9 million times 82 percent) will be those newly eligible for Medicaid.  (Note that all these estimates from the Medicare actuary came before the Supreme Court ruling, and may well be reduced as a result of same.)

The size and scope of the “woodwork effect” is a critical worry for states.  While states will receive the law’s new enhanced Medicaid federal match for newly eligible individuals, states will receive only their existing federal match rate – which could be as much as 50 percentage points lower – for those who are already eligible but use the 2014 “Big Bang” as a reason to sign up.  The fact that CBO projects millions more will enroll due to the “woodwork effect” is not a good sign for state budgets struggling to cope with their existing fiscal crises – to say nothing of the additional crisis placed upon the states by Obamacare.

Obamacare’s Raw Deal for States

Even as liberals attempt to argue that states should use Obamacare dollars to expand Medicaid because it’s a “good deal” for states, a report issued today provides clear reasoning why many states are thinking twice.  The report of the State Budget Crisis Task Force gives six “major threats to fiscal sustainability,” and Medicaid spending growth is tops on that list.  Because health costs continue to rise unabated, Medicaid spending is growing faster than state budget revenue.  As a result, Medicaid spending has soared over the past four years, to outstrip K-12 education as the top source of state expenses:

With Medicaid spending skyrocketing, what did Obamacare do to the situation?  It made it worse.  Over the past two fiscal years, states had to close a combined $146.3 billion in budget gaps — yet the law is about to impose new unfunded mandates on states of at least $118 billion.  And as today’s report again emphasizes, new Obamacare mandates prohibiting state flexibility in running their Medicaid programs “place an additional limitation on state cost reductions.”

Over and above the very real concerns that the federal government could engage in “bait-and-switch” tactics with states — enticing them into the Medicaid expansion with a high initial match rate, only to lower that rate and shift more costs to the states amid the coming federal budget crunch — many states will have to take a long look at the opportunity costs that participating in the Obamacare expansion will bring.  As the head of the National Association of Medicaid Directors noted, states paying even 10 percent of a very large and costly Medicaid expansion is a big number or their budgets to bear.  And at a time when other budget priorities are already being crowded out to finance Medicaid spending, taking more money from education, transportation, corrections, or elsewhere to pay for Obamacare’s unsustainable entitlement expansions may be a fiscal gamble states do not wish to make.

Obamacare’s “Self-Inflicted Wounds” on States

The Washington Post has a story out today about today’s semi-annual report on the Fiscal Survey of States.  The article notes that even as state revenues stabilize following the recession, the skyrocketing costs of Medicaid obligations are “leaving most [state] governments in dire fiscal straits.”  The report indicates that Medicaid spending rose a by 20.4 percent this fiscal year, after a double-digit increase of 10.6 percent in fiscal 2011.  Moreover, enrollment growth surged by 7.2 percent during the recession, and will continue to increase: “The implementation of [Obamacare] will greatly increase the individuals served in the Medicaid program” – by as much as 26 million people, according to the Administration’s own actuary.  As a National Governors Association press release on the survey noted, the growth in enrollees is raising Medicaid spending much faster than other areas of the budget; NGA Director Dan Crippen admitted that “spending priorities” – including things like education, transportation, and law enforcement – “will again face competition for state budget dollars” due to skyrocketing growth in Medicaid.

On a related topic, Inside Health Policy has an article (subscription required) outlining comments from Connecticut’s Medicaid director about how that state’s early expansion of Medicaid has become a “self-inflicted wound” on that state’s budget.  Using new authorities granted by Obamacare to expand Medicaid to low-income childless adults, the state experienced a 70 percent increase in enrollment in “about a year, year and a half’s time.”  Even though Connecticut was granted additional matching funds by the federal government, “our revenue expectations were eclipsed by the new obligations of a…population that rushed headlong into this new program,” according to the Medicaid director.  As the article noted, Connecticut’s experience “is a bit of a red flag, as it is indicative of the difficulty states face because they don’t really know how many people will be signing up for Medicaid in less than two years.”

Today’s state fiscal survey reveals that over the past two fiscal years, states had to close a combined $146.3 billion in budget gaps.  Yet Obamacare is about to impose new unfunded mandates on states of at least $118 billion.  And today’s stories show how Obamacare will impose more “self-inflicted wounds” on states through its misguided policies.  The state survey illustrates how skyrocketing Medicaid spending is crowding out other priorities, and Connecticut’s example shows how state budgets can be greatly impacted by millions of people “rush[ing] headlong into this new program” in 2014.  It’s more evidence why America should NOT “rush headlong” into creating this massive and unsustainable new entitlement state.

Single Payer Dystopia

Late last week, Los Angeles Times columnist David Lazarus wrote an article about an impending piece of legislation to be introduced by Rep. Jim McDermott.  According to the column, the bill would allow states to receive federal Medicare and Medicaid funds to establish state-based single-payer health insurance systems.  The article provides background on California’s numerous prior attempts to establish single-payer health care in the state, and quotes liberal advocates as saying the McDermott legislation could finally result in the single-payer dreams becoming reality.

Unfortunately, there are a few flaws in this logic.  Such as California’s $16 billion budget deficit, which has prompted Gov. Jerry Brown to ask voters to approve massive tax increases.  And there’s also this unwelcome element:  “A draft of McDermott’s bill says that to receive federal funds, states would have to offer a health care plan with the same benefits as the most popular plan available to federal government employees.”  That plan would be the Blue Cross Blue Shield standard option plan, which in 2010 cost a whopping $6,458.88 for a single person annually – 34% more than the average single premium for employer-provided health insurance in California that year.

To sum up:  At a time when California still faces double-digit unemployment and massive budget shortfalls, liberals think the state can use existing federal dollars to cover 7 million uninsured, provide 34% richer benefits to those with insurance, and save the state money in the process.  Some might argue that position is taking “California Dreamin’” to an extreme.  Because given economic malaise, budget constraints, and a platinum-plated package of mandated benefits, the single-payer health utopia liberals seek would, for millions of California residents, quickly turn into a dystopia.  Or even a Fruitopia.

Women Subjected to Medicaid’s Sub-Standard Care

During National Women’s Health Week, the Administration is making an attempt to promote Obamacare’s effects on women’s health.  However, one of the biggest effects the law will have on women’s health is its massive expansion of the highly flawed Medicaid program.  As of 2007, nearly 70 percent of Medicaid beneficiaries – ranging from women of child-bearing age to elderly seniors receiving long-term care – were female.  That’s a total of more than 41 million women receiving Medicaid benefits.

The problem is that, for these 41 million women, a Medicaid card doesn’t ensure access to care – let alone quality care:

  • Numerous studies have documented that in many cases, outcomes for patients on Medicaid are worse than those with no insurance at all.
  • Medicaid patients themselves don’t believe the program constitutes a legitimate benefit.  For instance, one struggling mother told the Wall Street Journal in 2007, “You feel so helpless thinking, something’s wrong with this child and I can’t even get her into a doctor….When we had real insurance, we could call and come in at the drop of a hat.”  That’s far from a ringing endorsement of the Medicaid program from one mother struggling to take care of her family.
  • The program’s dysfunctional culture “clearly condones gross underperformance” at both the state and federal levels – so said a caseworker for Deamonte Driver, the Maryland boy who died from a tooth infection in 2007 because he could not access care under the state’s Medicaid program.
  • The Medicaid program is so bad that not a single Democrat voted to place themselves in the program when given an opportunity to do so back in 2010.

Worse yet, Obamacare will expand Medicaid – without reforming the program.  According to the Administration’s own actuary, Obamacare will add nearly 26 million more individuals to this broken program.  At a time when states are struggling under the weight of budget deficits totaling a collective $175 billion, Obamacare is imposing new unfunded mandates of at least $118 billion.  And Obamacare precludes states from taking many types of actions that would modernize the program – and crack down on fraud – because of the new federal requirements being imposed.

Democrats have spent the last several weeks making politically-motivated claims about a supposed Republican “war on women.”  Some may argue that, before those individuals get carried away with their own self-righteousness, they take the time to contemplate the Medicaid ghetto into which they have consigned more than 41 million women – to say nothing of the millions more who will be subjected to Medicaid “care” under the 2700-page health care law.

What You Missed Over the Easter Recess

Just in case you were out of town for some or all of the prior two-week recess, here’s a quick rundown of the major events in health care that took place over the break…

Shocker: Obamacare Will Increase the Deficit:  Medicare public trustee Chuck Blahous released a report last week explaining how, after taking into account Medicare double-counting and other unrealistic assumptions, Obamacare will likely increase the deficit by hundreds of billions of dollars.  The White House’s response to the report noted favorable scores from the Congressional Budget Office – even though CBO itself admitted that the major savings assumptions in the law were unrealistic and unlikely to be sustained over the long term.  It’s also worth noting that Democrats’ claims Obamacare will reduce the deficit come from the same party that said the CLASS Act would be solvent for 75 years – which turned out to be a slight over-estimate, as the program was killed as unsustainable before it ever even got off the ground.

Another Obamacare Flop:  The Administration attempted to trumpet its latest round of accountable care organization (ACO) participants as a remarkable achievement.  However, as National Journal pointed out, the number of participating hospital and doctor groups (59 total) is less than one-fourth of the 270 ACOs the Administration predicted would participate last October – indicating that many providers remain reluctant to embrace the Administration’s top-down, government-centric approach to “controlling” health costs.

Thanks to Obamacare, You Can’t Spell Insurance without I-R-S:  The Hill reported that the Internal Revenue Service is in the process of receiving approximately half a billion dollars from a government “slush fund” to implement provisions of Obamacare.  This development comes after liberals derided Republican claims that Obamacare could result in the hiring of thousands of new IRS employees.  Moreover, the “slush fund” transfers come outside of the usual appropriations process, thus leading to a lack of accountability regarding this new funding, as Ways and Means Committee Chairman Camp pointed out in a letter to the IRS.

Liberal Advocate Admits Medicaid Stigmatizes the Poor…  One analyst at a liberal advocacy group told the Salt Lake City Tribune last week that “Medicaid and SCHIP already have a negative connotation in the community.”  A study by the Manhattan Institute bolstered this claim, as it quantified how Medicaid patients suffer from longer wait times and poorer health outcomes.  According to a recent report by the Medicare actuary, Obamacare will ensnare 25.9 million more Americans in a program that even liberals admit stigmatizes the poor.

…As Conservatives Show a Way to Reform the Program:  Even as liberals admitted that the current Medicaid program carries negative connotations, an editorial in the Wall Street Journal illustrated how the program can be enhanced through state flexibility, thereby improving care for patients and saving money as well.  The editorial highlighted a December study by non-partisan analysts at the Lewin Group on Rhode Island’s global compact waiver.  According to Lewin, the flexibility afforded Rhode Island’s Medicaid program “had a positive impact on controlling Medicaid expenditures,” and when it comes to disabled beneficiaries “reduced expenditures for this population while at the same time generally resulting in improved access to physician services.”  The contrast between flexibility yielding success in Rhode Island and Washington’s top-down mandates is stark – at a time when states face budget deficits totaling a collective $175 billion, Obamacare is imposing new unfunded mandates of at least $118 billion, thus undermining rather than supporting efforts like Rhode Island’s success story.

New Polls Confirm Obamacare’s Unpopularity:  A new poll of physicians under 40 showed their disapproval of the health care law – more than twice as many young doctors thought the law would have negative effects (49%) compared to positive outcomes (23%), and Obamacare (along with its myriad regulations) was the number one reason 57% of young physicians were pessimistic about the future of American health care.  A separate Fox News poll found that two-thirds of Americans believe the Supreme Court should strike down all of Obamacare (42%) or its unpopular individual mandate (24%).  The Fox poll also found that a majority (56%) of Americans believe President Obama was trying to intimidate the Supreme Court through his “unprecedented” attack on the Court (which fact-checkers debunked as being wildly inaccurate).

Read the Bill and It Won’t Pass:  A majority (55%) of Americans also told last week’s Fox poll they did not believe Obamacare would have passed if every Member of Congress actually read the bill before voting on it.  Recall that multiple Democrats publicly stated that reading the bill was a waste of time, because “we have to make judgments very fast,” and because “we hire experts” to read the bill instead.

Freedom under Renovations; Omen for SCOTUS’ Consideration of Obamacare?  According to the Architect of the Capitol’s office, workers began renovations on the statue of Freedom Triumphant in War and Peace above the Capitol on April 2.  The restoration and cleaning work is scheduled to be completed by mid-May.  Some may find the timing of this work ironic, as the renovations began the week after Supreme Court arguments on Obamacare, and will be completed by the expected June ruling.  Here’s hoping that Freedom is restored – both literally and metaphorically – later this spring.

Obamacare ALREADY a Failure

The liberal Center for American Progress today released a one-pager attempting to claim that Obamacare is already a success.  In reality, however, the law’s many flaws have become more manifest with each passing day:

Premiums Higher and Higher:  Candidate Obama said repeatedly his bill would CUT premiums by an average of $2,500 per family – meaning premiums would go DOWN, not merely just “go up by less than projected.”  The campaign also promised that that those reductions would occur within Obama’s first term.  However, the annual Kaiser Foundation survey of employer-provided insurance found that average family premiums totaled $12,860 in 2008, $13,375 in 2009, and $13,770 in 2010 and $15,073 this year.  In other words, while candidate Obama promised premiums would fall by $2,500 on average, premiums have already risen by $2,213 during the Obama Administration.

Millions Losing Coverage:  The Galen Institute last month released a paper discussing the havoc Obamacare is wreaking on insurance markets, and specifically the insurance many Americans had – and liked – before the massive 2700 page law was passed.  Dozens of carriers have left insurance markets, or gone out of business altogether – leaving millions in the lurch.  And millions more will lose their coverage; under the Administration’s own estimates, more than half of all employers – and up to 80% of small businesses – will lose their pre-Obamacare coverage by next year.

Millions More Exempted:  According to the latest data, the Administration has now granted waivers to over 1,700 health plans with more than 4 million people – more than half of them participants in union plans.  The fact that the Administration feels the need to exempt millions from the law’s mandates shows how onerous they are.  Even Democrat Senators have admitted the law is flawed – five Senators wrote to the Administration asking for another Obamacare waiver, because the law “may cause disruption for farmers and others in the agricultural sector” by causing members of farmer co-operatives to lose their current coverage.

Higher Taxes:  Several middle-class tax increases related to Obamacare have already taken effect: new restrictions on FSAs and Health Savings Accounts, and Obamacare’s first tax increase, on tanning products, which took effect in July 2010.  And in just a few months, more new taxes will take effect – including taxes on medical products and industries, which the Congressional Budget Office and other outside experts agree will be passed on to consumers, raising insurance premiums by as much as $5000 per family over a decade.  These taxes are collectively having an effect; in November, device manufacturer Stryker announced that it would be shedding “five percent of its workforce over concerns about the impending 2.3 percent medical device tax prescribed by” Obamacare.

Economic Uncertainty:  Multiple quotes from business executives have proven how Obamacare’s uncertainty is hampering economic recovery.  Analysts at UBS have stated that Obamacare is “arguably the biggest impediment to hiring, particularly hiring of less skilled workers.”  And the President of the Federal Reserve Bank of Atlanta admitted he has “frequently heard strong comments to the effect of ‘my company won’t hire a single additional worker until we know what health insurance costs are going to be.’”

One Bailout Program Bankrupt:  Last month the Administration admitted that Obamacare’s early retiree reinsurance program would shut down at the end of 2011.  The program was scheduled to run through 2014, but ran out of money years ahead of schedule.  The program went broke because unions and state governments rushed to the federal government to receive subsidies; HHS data indicate that more than half of the money went to only 24 organizations – with the biggest recipient being the United Auto Workers union.

Another Unsound Program Ended Before It Began:  In October, HHS finally admitted that the CLASS Act long-term care program was actuarially and fiscally unsound, and decided not to go forward with the program.  This development should shock no one – the Medicare actuary said on Day One the plan would not work, and one Democrat Senator called CLASS a “Ponzi scheme of the first order.”  But the Administration was forced to admit that its sanctimonious claims that CLASS was not a “business-as-usual Washington gimmick” were utterly FALSE.

Burdens Crushing States:  Last month’s annual State Expenditure Report released by the National Association of State Budget Officers illustrated how Medicaid is a large – and rapidly growing – portion of state budgets.  Yet at a time when states face budget deficits totaling a collective $175 billion, Obamacare is imposing new unfunded mandates of at least $118 billion.  These burdens have forced states to spend money on Medicaid that could otherwise be used to improve education, transportation, corrections, or other priority areas.

Nearly two years ago, Speaker Pelosi famously said we had to pass the bill to find out what’s in it.   All the signs above show how the American people are not liking what they’ve found in the 2700-page health care law.

Obamacare Hits the States (Again)

The website Stateline last week published an analysis of the major issues facing states in 2012, and not surprisingly Medicaid was high on that list.  While the recession hit states hard, Obamacare’s onerous new mandates have combined with the continued economic slowdown to inflict a devastating one-two punch on state budgets:

Two years ago, Medicaid eclipsed K-12 education as the most expensive item in state budgets.  Since then, it has only kept growing.  Medicaid now comprises 24 percent of state budgets, when federal funds are counted.  That’s up from 22 percent last year, according to the National Association of State Budget Officers.  The upward spiral seems to be continuing.  Even as states get ready to write their budgets for fiscal year 2013, which starts in July in most states, half of them expect to be wrestling with Medicaid shortfalls in their 2012 budgets, according to a survey by the Kaiser Family Foundation.

Making the job for fiscal 2013 even more difficult for states are new federal restrictions and an increasing number of court rulings that limit states’ options for trimming their programs….Other restrictions on states come from [Obamacare], which prevents states from doing anything that would lower enrollment.  In addition, a new federal rule proposed late last year would require states to produce data showing that cuts to hospital and doctor fees won’t make it harder for Medicaid patients to get the care they need….[Under Obamacare,] states are barred from doing anything that would lower Medicaid enrollment below the income levels called for in the national health law’s 2014 Medicaid expansion.  That includes raising premiums and co-pays to levels the federal government considers unaffordable for low-income patients.  That leaves states with relatively few options when it comes to controlling Medicaid costs.  They can reduce provider fees and eliminate optional benefits.

As the article demonstrates, Medicaid is a large – and growing – share of state budgets, and has increasingly begun to crowd out other potential priorities like education, corrections, transportation, etc.  Yet Obamacare only makes this budgetary mess worse, imposing new unfunded mandates of at least $118 billion.  Thus, even as the states (slowly) start to recover from the budgetary effects of the recession, the budgetary effects of Obamacare will have consequences for years – even decades – to come.

Eight Ways Obamacare Has Harmed Americans This Year

Yesterday the Administration released a blog post claiming eight ways in which Obamacare is helping Americans.  But in reality, there are far more ways in which the law is wreaking havoc on Americans’ health care and economic security.  Herewith are just eight (plus one!) of the ways in which Obamacare has harmed millions of Americans during 2011:

Higher Premiums:  One of the “success stories” cited in the White House blog post involved a premium increase in Oregon lowered to “only” about 10 percent.  But Candidate Obama repeatedly promised his health care plan would LOWER premiums by $2,500 per family, and do so within his first term.  So a 10 percent premium increase represents yet another broken promise by this Administration.  Sadly, skyrocketing premium increases remain the norm: The price of the average employer-sponsored plan ROSE by more than $2,200 per family since Obama was first elected in 2008, according to studies from the Kaiser Family Foundation.

Jobs Disappearing:  All over the country, firms are having to lay off workers as a result of Obamacare’s tax increases and regulations.  Last month, device manufacturer Stryker announced that it would be shedding “five percent of its workforce over concerns about the impending 2.3 percent medical device tax prescribed by” Obamacare.  And in October, one insurance carrier announced plans to eliminate 110 jobs in Nebraska and Iowa as a “fairly predictable consequence” of Obamacare’s regulations.  That’s a long way from the 4 million jobs Speaker Pelosi claimed Obamacare would create.

Jobs Not Being Created:  Just this week, the owner of the Carl’s Jr. franchise wrote an op-ed in which he discussed the uncertainty surrounding Obamacare, and the fact that his business will reduce capital spending and hiring in anticipation of higher health care costs.  Other experts agree: Investment firm UBS has said Obamacare is “arguably the biggest impediment to hiring,” and the President of the Atlanta Fed said “we’ve frequently heard strong comments to the effect of ‘my company won’t hire a single additional worker until we know what health insurance costs are going to be.’”

Lost Coverage:  The Galen Institute recently released a paper chronicling all the plans that have dropped coverage since Obamacare was enacted into law – literally dozens of plans affecting millions of consumers nationwide.  Sadly, these results are far from atypical; the Administration’s own estimates found that half of all employers – and up to 80% of all small businesses – would lose their current health plan by 2013.

Paperwork Galore:  Already, the Administration has released more than 10,000 pages of regulations and notices regarding Obamacare – and the effects are echoing throughout the health care system.  USA Today recently reported that some medical facilities are actually laying off clinical staff to hire more administrative employees to deal with Obamacare-related paperwork.  And one hospital in Alabama decided to start imposing a new $25 annual fee on its patients to cover the “huge increase in paperwork” and “mountains of new forms” resulting from Obamacare.

Waivers and Favors:  One obvious symbol of Obamacare’s onerous impacts on Americans’ health insurance is the myriad exemptions being granted from the law.  As of July, the Administration approved a whopping 1,578 waivers exempting 3.4 million Americans, many of whom are in union plans, from just some of the law’s mandates.  Even Senate Democrats were forced to send a letter to the Administration asking for a separate waiver from one of Obamacare’s provisions, noting that the law “may cause disruption for farmers and others in the agricultural sector.”

You Can’t Spell Insurance Without I-R-S:  The Wall Street Journal reported on the consequences of just one of Obamacare’s tax increases – restrictions on consumer-directed health accounts like Flexible Spending Arrangements (FSAs) and Health Savings Accounts (HSAs).  New paperwork requirements led physicians to revolt: “‘I am now doing the IRS’s work, and that’s what I resent most,’” said one pediatrician.  And that’s not the only IRS-related provision bogged down in paperwork: An Inspector General report recently revealed that takeup of the small business tax credit has been far short of predictions, possibly because claiming the credit involves filling out seven different worksheets.

Raising Mandates, Raising Costs:  The 15-page guidance released by HHS earlier this month gives states the “flexibility” to impose more benefit mandates, not fewer.  It does so by allowing states to mandate an extremely rich benefit package, and do so without paying for the financial consequences of their decision – because the costs instead will be foisted on federal taxpayers funding insurance subsidies in that state.  At this rate, the Congressional Budget Office estimate of a $2,100 per family increase in individual insurance premiums due to Obamacare could very well be an under-estimate.

States Saddled by Mandates:  The annual State Expenditure Report released by the National Association of State Budget Officers revealed that Medicaid is consuming an ever-larger portion of state budgets, much faster than spending on education, corrections, or transportation.  And the reason why Medicaid is crowding out other portions of state budgets is Obamacare; at a time when states face budget deficits totaling a collective $175 billion, Obamacare is imposing new unfunded mandates of at least $118 billion.  Earlier this month the non-partisan Lewin Group released an analysis of the Rhode Island Medicaid program’s global compact waiver, revealing that the state saved tens of millions of dollars through flexibility – progress made despite the Obama Administration’s efforts, not because of them.  While other states could achieve similar savings, the Administration has refused governors’ multiple requests for flexibility from the new Medicaid mandates included in Obamacare.