Quotes on Patient Protection and Affordable Care Act

"A tax, in the general understanding and in the strict constitutional sense, is an exaction for the support of Government; the term does not connote the expropriation of money from one group to be expended for another, as a necessary means in a plan of regulation...."

U.S. Supreme Court
January 6, 1936
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Library Topic: Regulations in America

"The question in such cases is not what powers the Federal Government ought to have, but what powers have, in fact, been given it by the people. ...

Ours is a dual form of government; in every State there are two Governments -- the State and the United States; each State has all governmental powers save such as the people, by the Constitution, have conferred upon the United States, denied to the States, or reserved to themselves."

U.S. Supreme Court
January 6, 1936
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Library Topic: Constitutional Limits

"The Government of the United States is a Government of delegated powers; it has only such powers as are expressly conferred upon it by the Constitution and such as are reasonably to be implied from those expressly granted."

U.S. Supreme Court
January 6, 1936
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Library Topic: Constitutional Limits

"The power to tax and spend is a separate and distinct power; its exercise is not confined to the fields committed to Congress by the other enumerated grants of power, but it is limited by the requirement that it shall be exercised to provide for the general welfare of the United States."

U.S. Supreme Court
January 6, 1936
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Library Topic: Constitutional Limits

"Congress cannot invade state jurisdiction by purchasing the action of individuals any more than by compelling it."

U.S. Supreme Court
January 6, 1936
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"National health insurance is the most effective single way to meet the Nation's health needs. Because adequate treatment of many illnesses is expensive and its cost cannot be anticipated by the individual, many persons are forced to go without needed medical attention. Children do not receive adequate medical and dental care. Symptoms which should come early to the attention of a physician are often ignored until too late. The poor are not the only ones who cannot afford adequate medical care. The truth is that all except the rich may at some time be struck by illness which requires care and services they cannot afford. Countless families who are entirely self-supporting in every other respect cannot meet the expense of serious illness."

President Harry S Truman
The American Presidency Project
May 19, 1947
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"A national health insurance program is a logical extension of the present social-security system which is so firmly entrenched in our American democracy. Of the four basic risks to the security of working people and their families--unemployment, old age, death and sickness--we have provided some insurance protection against three. Protection against the fourth--sickness--is the major missing element in our national social insurance program."

President Harry S Truman
The American Presidency Project
May 19, 1947
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"Under the [nationalized insurance] program which I have proposed patients can and will be as free to select their own doctors as they are today."

President Harry S Truman
The American Presidency Project
May 19, 1947
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“A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States. An individual mandate would have two features that, in combination, would make it unique. First, it would impose a duty on individuals as members of society. Second, it would require people to purchase a specific service that would be heavily regulated by the federal government."

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"This is also an income shift -- it's a shift, it's a leveling to help lower income Americans. Too often, much of late, the last couple three years the mal-distribution of income in America is gone up way too much, the wealthy are getting way, way too wealthy, and the middle income class is left behind. Wages have not kept up with increased income of the highest income in America. This legislation will have the effect of addressing that mal-distribution of income in America, because healthcare is now a right for all Americans, because healthcare is now affordable for all Americans."

US Senator Max Baucus (D-Mont.)
March 25, 2010
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"More than 2,500 pages and 500,000 words long, ... the Patient Protection and Affordable Care Act represents the most significant transformation of the American health care system since Medicare and Medicaid. It will fundamentally change nearly every aspect of health care from insurance to the final delivery of care."

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"With enactment of the Patient Protection and Affordable Care Act (PPACA), … Congress is imposing a mandate on citizens, effective January 1, 2014, to purchase a federally approved level of health insurance. …

Under Section 1501, individuals will be assessed a monetary penalty if they do not purchase a health insurance plan that meets the federal definition of ‘minimum essential benefits.' Congress finds, in Section 1501(a), that health care is inextricably connected with interstate commerce thus claiming a constitutional power to require that citizens purchase a specified level of coverage. The penalty for failure to make such a purchase is to be the greater of a flat dollar amount or a percentage of income, phased in from 1 percent to 2.5 percent of income by 2016. The penalty is to be phased in over a three-year period, with the flat dollar amount set at $95 in 2014, $325 in 2015, and $695 in 2016."

Robert E. Moffit Ph.D.
Obamacare and the Individual Mandate: Violating Personal Liberty and Federalism
The Heritage Foundation
January 18, 2011
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"The constitutional fight over ObamaCare reaches far beyond medicine. At issue is protection of individual liberty. Are there any limits left to Washington's reach?"

Doug Bandow
Cato Institute
February 14, 2011
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"The congressional mandate on American citizens to purchase health insurance is unprecedented. ... It is one of the most controversial provisions of the new law, ... setting off a record number of state lawsuits and launching a large number of state legislative countermeasures. ... The Administration has also been inconsistent, with President Obama originally opposing an individual mandate ... but then endorsing it. The President stated that the penalty was not a tax, but then Administration lawyers insisted it was, stressing that Congress’s 'sweeping' taxing power was 'the linchpin' of their argument for the mandate’s constitutionality. ... Certain propositions are increasingly clear.

It Is an Unconstitutional Violation of Personal
Liberty and Strikes at the Heart of American Federalism."

Robert E. Moffit Ph.D.
Obamacare and the Individual Mandate: Violating Personal Liberty and Federalism
The Heritage Foundation
January 18, 2011
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"It is with great humility and with great pride that we tonight will make history for our country and progress for the American people. ... Just think–we will be joining those who established Social Security, Medicare, and now tonight health care for all Americans. ...

In doing so, we will honor the vows of our founders, who in the Declaration of Independence said that we are 'endowed by our Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness.' This legislation will lead to healthier lives, more liberty to pursue hopes and dreams and happiness for the American people. This is an American proposal that honors the traditions of our country."

Speaker Nancy Pelosi
The Gavel
March 21, 2010
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"The top-down federal approach to health care reform assaults the traditional state role in insurance regulation, squashes innovation, and undermines real choice and competition. PPACA is thus a bad deal for states, reducing them to mere agents of federal health and insurance policy."

Robert E. Moffit Ph.D.
The Case Against Obamacare: A Health Policy Series for the 112th Congress
The Heritage Foundation
January 18, 2011
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"The Affordable Care Act is not just a law designed to cover the majority of our nation’s uninsured, moving us into the league of industrialized nations which guarantee universal health coverage for its citizens. The law also takes the crucial first steps toward reining in our runaway health care costs. It ends discriminatory insurance practices that leave many of our citizens one bad gene, or badly timed accident, away from personal bankruptcy. It does so while introducing insurance market competition that will lead to lower health insurance premiums for some, and better coverage for others, in the so-called nongroup insurance market where workers without employer-provided health insurance turn for coverage. The Affordable Care Act does all this while significantly reducing our enormous federal budget deficit over the next 10 years."

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"The Patient Protection and Affordable Care Act (PPACA) ... imposes numerous tax hikes that transfer more than $500 billion over 10 years—and more in the future—from hardworking American families and businesses to Congress for spending on new entitlements and subsidies. In addition, higher tax rates on working and investing will discourage economic growth both now and in the future, further lowering the standard of living."

Curtis Dubay
The Case Against Obamacare: A Health Policy Series for the 112th Congress
The Heritage Foundation
January 20, 2011
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"If the new Congress wants to improve health care quality and lower costs, it should do what it can to support all the cost-containing measures in the already-enacted law."

Peter Orszag
The New York Times
November 3, 2010
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"One of the central goals of the Patient Protection and Affordable Care Act (PPACA) ... was to increase the number of individuals with health insurance coverage. To encourage employers to offer coverage, the new law creates a tax penalty on firms with more than 50 workers that fail to provide 'adequate' coverage for their employees. The result is government intrusion into voluntary arrangements made between employer and employee.

The cost of the tax penalty will ultimately be borne by workers (lower wages and fewer jobs), shareholders (lower profits), and consumers (higher prices)."

Brian Blase
The Case Against Obamacare: A Health Policy Series for the 112th Congress
The Heritage Foundation
January 19, 2011
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"[The] increased costs that PPACA places on businesses will in turn reduce business growth and hiring. The CBO predicts that PPACA will reduce the amount of labor being used in the economy by approximately one-half of 1 percent. ... This equates to about 700,000 additional Americans being unemployed."

Brian Blase
The Heritage Foundation
January 19, 2011
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"The exchange with Speaker Pelosi on Thursday occurred as follows:

CNSNews.com: '
Madam Speaker, where specifically does the Constitution grant Congress the authority to enact an individual health insurance mandate?'

Pelosi: '
Are you serious? Are you serious?'

CNSNews.com: '
Yes, yes I am.'"

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"The individual mandate is outside Congress' Commerce Clause power, and it cannot be otherwise authorized by an assertion of power under the Necessary and Proper Clause. It is not Constitutional."

Mr. Chief Justice Vinson
U.S. District Court For The Northern District Of Florida Pensacola Division
January 31, 2011
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"Younger adults will be particularly hard-hit by PPACA’s new restriction on age rating of premiums. The natural variation by age in medical costs is about 5 to 1—meaning that the oldest group of (non-Medicare) adults normally consumes about five times as much medical care as the youngest group. Thus, if an average 64-year-old consumes five times as much medical care as an average 21-year-old, PPACA’s stipulation that an insurer cannot charge a 64-year-old more than three times what it charges a 21-year-old will have the effect of artificially 'compressing' normal age-related premium variations.

This mandated 'rate compression' forces insurers to both under-price coverage for older people and overprice coverage for younger individuals. Actuaries estimate that the effect will be to increase premiums for those ages 18–24 by 45 percent and those ages 25–29 by 35 percent while decreasing premiums for those ages 55–59 by 12 percent and those ages 60–64 by 13 percent."

Edmund F. Haislmaier
The Case Against Obamacare: A Health Policy Series for the 112th Congress
The Heritage Foundation
January 20, 2011
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"Interestingly, the [PPACA] law may have created the worst of both worlds, a mandate that is costly and violates individual liberty, but one that is still weak enough that it may be cheaper for many individuals to pay the penalty than to purchase insurance. As a result it may fall far short of its proponents’ goal of bringing young and healthy individuals, who today frequently forego insurance, into the insurance pool."

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"The new health care law has states and citizens lining up — but not quite in the way President Obama or Congress had hoped. Across the country, lawsuits are being filed that could have sweeping implications, not just for health care but our constitutional system. … One of the most contested issues is the so-called individual mandate under which Congress has ordered all citizens to get medical insurance or face fines. Though the federal government has the clear advantage in such litigation, these challenges should not be dismissed as baseless political maneuvering. There is a legitimate concern for many that this mandate constitutes the greatest (and perhaps the most lethal) challenge to states' rights in U.S. history."

Jonathan Turley
USA Today
March 31, 2010
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"All Americans have a stake in the ongoing constitutional litigation over ObamaCare. First is saving the health care system from Uncle Sam's not so tender mercies. Second is enforcing one of the important limits on national power. If the justices instead rule that the Constitution no longer means what it says, then no Americans' liberty will be secure."

Doug Bandow
Cato Institute
February 14, 2011
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"ObamaCare doesn't reduce medical costs under even the rosiest of scenarios (that is, projections that take seriously all its creators' assumptions). What we can be certain of is that this legislation increases the amount of money taxpayers will be forced by law to pay for health insurance to the tune of $420 billion over the next 10 years. Claims about ObamaCare’s deficit-reduction effects depend on new taxes growing even faster than new spending."

Veronique de Rugy
Reason Magazine
November 4, 2010
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"Perhaps the single most important aspect of the [PPACA] law is its individual mandate, a legal requirement that every American obtain health insurance coverage that meets the government’s definition of 'minimum essential coverage.' Those who don’t receive such coverage through government programs, their employer, or some other group would be required to purchase individual coverage on their own. 

This individual mandate is unprecedented in U.S. governance. Back in 1993, when the Clinton health care plan was under consideration, the Congressional Budget Office noted: 'A mandate requiring all individuals to purchase health insurance would be an unprecedented federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States.' ... Moreover, the individual mandate raises serious constitutional questions. ... Even the Congressional Research Service was not able to conclude it was constitutional!"

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"The health care law starts the arduous process of shifting the medical payment system away from an emphasis on quantity of care and toward an emphasis on quality. For example, it creates penalties for hospitals with high rates of readmission and hospital-acquired infections. It expands the practice of making a single payment for treating a specific condition rather than paying for each treatment. And it provides for accountable care organizations that financially bind doctors and hospitals so that they offer the coordinated care that experts believe would save money in complex cases."

Peter Orszag
The New York Times
November 3, 2010
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"In addition to slow and uncertain revenue growth, contacts in this recovery are frequently citing a number of other factors that are impeding hiring. Prominent among these is the lack of clarity about the cost implications of the recent health care legislation. 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.'"

Dennis P. Lockhart
Federal Reserve Bank of Atlanta
November 11, 2010
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"The relatively minor provisions of the law that have taken effect to date are already killing jobs, increasing premiums and taxes, reducing take-home pay, causing private-insurance markets to collapse, and throwing Americans out of their health plans. Yet today's cost increases and other dislocations will look like the good old days compared with what Americans will suffer when — if — they allow Obamacare to take full effect. The nonpartisan Congressional Budget Office projects, for example, that Obamacare will permanently eliminate 800,000 jobs by 2021. That's not to mention any temporary job losses."

Michael F. Cannon
National Review
Cato Institute
March 21, 2011
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"Rather than beat their plowshares into swords, Obamacare opponents in most state capitols are laying the bureaucratic foundations for the law's new entitlement spending and lending it legitimacy by accepting its debt-financed federal grants. Secretary of health and human Services Kathleen Sebelius boasts that 48 states have already accepted at least $1 million each from the federal government to help them plan their exchanges."

Michael F. Cannon
National Review
Cato Institute
March 21, 2011
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"Because I find both the 'uniqueness' and 'economic decision' arguments unpersuasive, I conclude that the individual mandate seeks to regulate economic inactivity, which is the very opposite of economic activity. And because activity is required under the Commerce Clause, the individual mandate exceeds Congress’ commerce power, as it is understood, defined, and applied in the existing Supreme Court case law."

Mr. Chief Justice Vinson
U.S. District Court For The Northern District Of Florida Pensacola Division
January 31, 2011
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"It's not surprising that opponents, having lost in Congress, have taken to the courts. We saw similar challenges to laws that created Social Security and established new civil rights protections. Those challenges ultimately failed, and so will this one.

Rather than fighting to undo the progress we've made, and returning to the days when one out of seven Americans was denied insurance due to their medical histories, supporters of repeal should work with us to implement this law effectively. The initial decisions about the Affordable Care Act will be reviewed on appeal. We are confident that the law will ultimately be upheld."

Eric H. Holder Jr.
Kathleen Sebelius
The Washington Post
December 14, 2010
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"If Congress intends to implement health care reform --- and there would appear to be widespread agreement across the political spectrum that reform is needed --- it should do a comprehensive examination of the Act and make a legislative determination as to which of its hundreds of provisions and sections will work as intended without the individual mandate, and which will not. It is Congress that should consider and decide these quintessentially legislative questions, and not the courts."

Mr. Chief Justice Vinson
U.S. District Court For The Northern District Of Florida Pensacola Division
January 31, 2011
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"The operational feasibility of an individual mandate depends in part on the challenges that must be addressed to implement the mandate. An individual mandate would by definition provide an incentive for individuals to purchase health insurance when they might not have done so otherwise. However, no mandate will result in 100 percent compliance, as has been seen through the limited experience with health insurance mandates in some states and other countries, as well as through experience with mandates in other areas of the law, such as automobile insurance, child support, and taxation ...."

RAND Corporation
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"Another fundamental flaw in our current health care system before passage of the Affordable Care Act was that individuals could 'free ride,' remaining uninsured until they need care and then turning to emergency rooms. Emergency rooms are required by law to provide care to all regardless of insurance coverage. The associated uncompensated care costs of treating these individuals amount to a more than $40 billion a year tax on the insured in the United States.

The Affordable Care Act ends this free riding by requiring that individuals purchase insurance if it is affordable for them (which it will be for most due to the subsidies described earlier). This personal responsibility requirement, originally the brainchild of Republican experts, would end the unfairness of a system where emergency room health care providers are required to treat everyone but individuals are not in turn required to pay their fair share of the costs of treatment. Repealing the new law would mean returning to a world where individuals can simply wait until they are sick to get treated, passing the costs on to the rest of society that is paying their share."

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"Widespread failure to purchase health insurance under an individual mandate increases health insurance costs for other members of society and presents practical administrative and financing problems when noncomplying individuals need health care."

RAND Corporation
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"All individuals will be required to have health insurance, with some exceptions, beginning in 2014. Those who do not have coverage will be required to pay a yearly financial penalty of the greater of $695 per person (up to a maximum of $2,085 per family), or 2.5% of household income, which will be phased-in from 2014-2016. Exceptions will be given for financial hardship and religious objections; and to American Indians; people who have been uninsured for less than three months; those for whom the lowest cost health plan exceeds 8% of income; and if the individual has income below the tax filing threshold ($9,350 for an individual and $18,700 for a married couple in 2009)."

Focus on Health Reform
Kaiser Family Foundation
April 28, 2010
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"Should everyone be required to have health insurance? The short answer is no. There is nothing that can be achieved with a mandate to buy health insurance that cannot be better achieved by a carefully designed system of tax subsidies. Beyond that, a requirement that everyone obtain insurance (as the new health reform law dictates) creates problems greater than the problem it is designed to solve."

John C. Goodman
Health Affairs Blog
National Center For Policy Analysis
May 10, 2010
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"Right now, the insurer sets the rules. It collects background information on applicants and then varies the price and availability of insurance to discriminate against those who are likely to use it. Health-care reform is going to render those practices illegal. An insurer will have to offer insurance at the same price to a diabetic and a triathlete.

But if you remove the individual mandate, you're caught in the reverse of our current problem: The triathlete doesn't buy insurance. Fine, you might say. Let the insurer get gamed. They deserve it.

The insurers, however, are not the ones who will be gamed. The sick are. Imagine the triathlete's expected medical cost for a year is $200 and the diabetic's cost is $20,000. And imagine we have three more people who are normal risks, and their expected cost in $6,000. If they all purchase coverage, the cost of insurance is $7,640. Let the triathlete walk away and the cost is $9,500. Now, one of the younger folks at normal cost just can't afford that. He drops out. Now the average cost is $10,600. This prices out the diabetic, so now she's uninsured. Or maybe it prices out the next normal-cost person, so costs jump to $13,000.

This is called an insurance death spiral. If the people who think they're healthy now decide to wait until they need insurance to purchase it, the cost increases, which means the next healthiest group leaves, which jacks up costs again, and so forth.

Kill the individual mandate and you're probably killing the bill, too. The mandate is what keeps average premium costs low, because it keeps healthy people in the insurance pool."

Ezra Klein
The Washington Post
December 16, 2009
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"Interestingly enough, Obama has waived the onerous Obamacare rules for quite a few healthcare providers, too. One wonders how good Obamacare could be if the rules are waived for actual healthcare providers?"

Warner Todd Huston
Big Government
November 15, 2010
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"But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy."

Speaker Nancy Pelosi
March 9, 2010
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"...over 1,000 sponsors of health plans have received waivers from Obamacare’s annual limit requirements. In February 2011, HHS approved 94 percent of waiver applications. The largest waiver thus far is for the United Federation of Teachers Welfare Fund in New York and its 351,000 enrollees."

Brian Blase
Backgrounder, #2532
The Heritage Foundation
March 17, 2011
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"In the context of current health insurance market circumstances and the framework of the legislation, the use of an individual mandate, structured as it is to ensure affordability for all who are subject to it, is likewise an eminently rational and well-supported (‘necessary and proper’ in the words of Article I, §8) means for achieving these goals. The same goals and choice of means fit the mandate snugly within precedents broadly defining Congress’ authority to tax and spend.

Opponents’ arguments to the contrary express philosophical objections to the concept of mandatory health insurance in principle, without regard to the practical issues the Supreme Court has always used to evaluate laws challenged as outside Congress’ interstate commerce authority: the practical impact of the mandate on commerce or the public welfare or the welfare of affected individuals, or the rationality of Congress’ judgments about its impact on statutory goals. No doubt, in some quarters, opponents’ libertarian views are deeply felt. But they have no basis in law, neither in the grants of authority to Congress in Article I nor in limitations on that authority in the Bill of Rights, nor in the case law interpreting these provisions."

Simon Lazarus
Issue Brief
American Constitution Society For Law And Policy
December 2009
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"The Affordable Care Act is not a government takeover of the U.S. health system; it is a means of using reformed private nongroup insurance markets to more effectively fight the steady decline in employer-provided group insurance. Repeal means a fundamental retreat from the promise of private health insurance coverage for our citizens."

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"Within two months of the passage of Obamacare, the job market stopped improving. This suggests that businesses are not exaggerating when they tell pollsters that the new health care law is holding back hiring. ...

The fact that improvements in the job market ground to a halt after Congress passed Obamacare does not prove that the health care law caused it—correlation cannot prove causation. However, the fact does lend strong weight to the voices of businesses who say that the law is preventing hiring.

In a recent survey, 33 percent of business owners said the health care law was either their greatest or second-greatest obstacle to new hiring."

James Sherk
Webmemo, #3316
The Heritage Foundation
July 19, 2011
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"Properly formulated, we perceive the question before us to be whether the federal government can issue a mandate that Americans purchase and maintain health insurance from a private company for the entirety of their lives. ... These types of purchasing decisions are legion. Every day, Americans decide what products to buy, where to invest or save, and how to pay for future contingencies such as their retirement, their children’s education, and their health care. The government contends that embedded in the Commerce Clause is the power to override these ordinary decisions and redirect those funds to other purposes. Under this theory, because Americans have money to spend and must inevitably make decisions on where to spend it, the Commerce Clause gives Congress the power to direct and compel an individual’s spending in order to further its overarching regulatory goals, such as reducing the number of uninsureds and the amount of uncompensated health care.

In answering whether the federal government may exercise this asserted power to issue a mandate for Americans to purchase health insurance from private companies, we next examine a number of issues: (1) the unprecedented nature of the individual mandate; (2) whether Congress’s exercise of its commerce authority affords sufficient and meaningful limiting principles; and (3) the far-reaching implications for our federalist structure. ...

Both parties have cited extensively to previous Supreme Court opinions defining the scope of the Commerce Clause. Economic mandates such as the one contained in the Act are so unprecedented, however, that the government has been unable, either in its briefs or at oral argument, to point this Court to Supreme Court precedent that addresses their constitutionality. Nor does our independent review reveal such a precedent. ...

What the Court has never done is interpret the Commerce Clause to allow Congress to dictate the financial decisions of Americans through an economic mandate."

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"The fact that Congress has never before exercised this supposed authority is telling. As the Supreme Court has noted, 'the utter lack of statutes imposing obligations on the States’ executive (notwithstanding the attractiveness of that course to Congress), suggests an assumed absence of such power.' Few powers, if any, could be more attractive to Congress than compelling the purchase of certain products. Yet even if we focus on the modern era, when congressional power under the Commerce Clause has been at its height, Congress still has not asserted this authority. Even in the face of a Great Depression, a World War, a Cold War, recessions, oil shocks, inflation, and unemployment, Congress never sought to require the purchase of wheat or war bonds, force a higher savings rate or greater consumption of American goods, or require every American to purchase a more fuel efficient vehicle."

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In sum, the individual mandate is breathtaking in its expansive scope. It regulates those who have not entered the health care market at all. It regulates those who have entered the health care market, but have not entered the insurance market (and have no intention of doing so). It is overinclusive in when it regulates: it conflates those who presently consume health care with those who will not consume health care for many years into the future. The government’s position amounts to an argument that the mere fact of an individual’s existence substantially affects interstate commerce, and therefore Congress may regulate them at every point of their life. This theory affords no limiting principles in which to confine Congress’s enumerated power."

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"[W]e conclude that the individual mandate contained in the Act exceeds Congress’s enumerated commerce power. This conclusion is limited in scope. The power that Congress has wielded via the Commerce Clause for the life of this country remains undiminished. Congress may regulate commercial actors. It may forbid certain commercial activity. It may enact hundreds of new laws and federally-funded programs, as it has elected to do in this massive 975-page Act. But what Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.

It cannot be denied that the individual mandate is an unprecedented exercise of congressional power."

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"Thus, the text of the individual mandate unambiguously provides that it imposes a penalty. The penalty encourages compliance with the Act’s requirement to obtain 'minimum essential coverage' by imposing a monetary sanction on conduct that violates that requirement. The text is not unclear and was carefully selected to denote a specific meaning."

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"The very nature of congressional findings about the individual mandate further amplifies that Congress designed and intended to design a penalty for the failure to comply and not a tax. The source of the power, asserted by Congress, to create the mandate is directly pegged to the Commerce Clause. ...

Indeed, the findings make clear that the goal of the individual mandate is not to raise revenue for the public fisc, but rather to, among other things, reduce the number of the uninsured and to create what Congress perceived to be effective health insurance markets that make health insurance more widely available. ...

Congress repeatedly told us that the individual mandate is a 'penalty' and expressly invoked its Commerce Clause power as the foundation for the mandate. The two are not the same thing. Ultimately, we are hard pressed to construe the statute in a manner that would require us to ignore the plain text of the statute, the words repeatedly employed by Congress, well-settled principles of statutory construction, and well-settled law emphasizing the substantive distinction between a tax and a penalty."

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"After careful review of the statute, we conclude that the individual mandate is a civil regulatory penalty and not a tax. As a regulatory penalty, the individual mandate must therefore find justification in a different enumerated power. ...

The individual mandate as written cannot be supported by the tax power."

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"'The whole structure of the law collapses without a state-run exchange,'" said Michael Cannon, director of health policy studies at the libertarian Cato Institute. 'That forces Congress to either repeal ObamaCare or significantly alter it.'"

David Hogberg
Investors Business Daily
OCI Services
September 26, 2011
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"The commerce clause gives Congress authority to regulate interstate commerce. Since the 1930s, Supreme Court decisions have interpreted the commerce clause broadly. But every previous case expanding the commerce power involved some sort of 'economic activity,' such as operating a business or consuming a product. Failure to purchase health insurance is neither commerce nor an interstate activity. Indeed, it is the absence of commerce.

If Congress could use that clause to regulate mere failure to buy a product on the grounds that such inaction has an economic effect, there would be no structural limits to its power."

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"Two years ago, when introducing then promptly enacting Obamacare, the president stated that healthcare law reform would not cost a penny over $1 trillion ($900 billion to be precise), and that it would not add 'one dime' to the debt. It appears that this estimate may have been slightly optimistic… by a factor of 1700%. Because coincident with the recent Supreme Court debacle, in which a constitutional law president may be about to find that his magnum opus law is, in fact, unconstitutional, someone actually read the whole thing cover to cover, instead of merely relying on the CBO's, pardon Morgan Stanley and Goldman Sachs', funding estimates. That someone is Republican Jeff Sessions who after actually running the numbers has uncovered that the true long-term funding gap is a mind-boggling $17 trillion, just a tad more than the original sub $1 trillion forecast. This latest revelation means that total underfunded US welfare liabilities: Medicare, Medicaid and social security now amount to $99 trillion!"

Tyler Durden
Zero Hedge
March 30, 2012
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"...while Obama may have been taking creative license with a number that is greater than total US GDP, he was most certainly correct when saying that Obamacare would not add a penny to US debt. Because the second the US government comes to market to fund a true total debt/GDP ratio of 750%, it is game over, and the Fed will have its hands full selling Treasury puts every waking nanosecond to have any time left for the daily 3pm stock market ramp."

Tyler Durden
Zero Hedge
March 30, 2012
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"This afternoon, a three-judge panel of the U.S. Eleventh Circuit Court of Appeals in Atlanta ruled that the individual mandate in the Patient Protection and Affordable Care Act (PPACA), more commonly known as Obamacare, is unconstitutional. The carefully worded and thorough (over 300 page) set of opinions may be a bit mind-numbing for the uninitiated, but they are a joy to read for those of...

According to Peter Suderman, the AARP endorsement of Obamacare seemed like a good idea at the time, but is increasingly growing less appealing to AARP's members and employees. One reason for the increased dissatisfaction with the law is the fact that AARP...

"The new health care law is known as the Affordable Care Act. But Democrats in Congress and advocates for low-income people say coverage may be unaffordable for millions of Americans because of a cramped reading of the law by the administration and by the Internal Revenue Service in particular.

Under rules proposed by the service, some working-class families would be unable to afford...

A commentary timeline on the history of health care reform from President Franklin Roosevelt to George W. Bush.

"All eyes will be on the Supreme Court on Thursday morning, as justices are expected to hand down their ruling on the controversial healthcare reform law passed by President Barack Obama and a Democratically-controlled Congress in 2010."

"Two-thirds of Americans say the U.S. Supreme Court should throw out either the individual mandate in the federal health care law or the law in its entirety, signaling the depth of public disagreement with that element of the Affordable Care Act.

This ABC News/Washington Post poll finds that Americans oppose the law overall by 52-41 percent. And 67 percent believe the high court should...

"The nation's universities are opening more medical schools as graduate medical education transforms to address the nation's physician shortage."

"In an interview with The Daily Caller, the president of the American Medical Student Association (ASMA) praised President Barack Obama's health-care overhaul, denying that it is a 'political' issue and insisting that medical students are better equipped to determine the best course for U.S. health care than seasoned but less idealistic physicians."

"Last Friday, the White House announced that it would revise the controversial ObamaCare birth-control mandate to address religious-liberty concerns. Its proposed modifications are a farce."

In this brief speech, Dennis Lockhart discusses why many businesses are not hiring during the recession. According to Lockhart, one of the big reasons behind this is uncertainty over the upcoming healthcare bill.

"The Catholic University of America has joined dozens of Catholic institutions across the country in filing suit against the U.S. government because the administration has refused to take seriously our profoundly held conviction that the mandate from the Department of Health and Human Services intrudes on our constitutionally protected religious liberty by attempting to compel us to provide surgical sterilization and contraceptives to those whom we insure."

"President Obama's national health care law will cost $1.76 trillion over a decade, according to a new projection released today by the Congressional Budget Office, rather than the $940 billion forecast when it was signed into law."

"Earlier this week, the Congressional Budget Office released its revised estimates of what Obamacare will cost, now that the Supreme Court has weighed in. As I read the report, it occurred to me to ask: how have the CBO's estimates changed over time? It turns out that, even when you compare the years that are common to each CBO report, a clear trend emerges. Today, the CBO believes that...

"President Obama has called Rep. Paul Ryan's budget 'an attempt to impose a radical vision on our country,' but as this week's chart illustrates, if something radical doesn't happen, entitlement spending will nearly double by 2050. The amount of spending on Medicare, Medicaid, Social Security and Obamacare subsidies will soar over the next 38 years, leaving future generations with an alarming...

"President Obama has reassured Americans that if they like their current health insurance, they can keep it.

'If you've got health insurance through your employer, you can keep your health insurance, keep your choice of doctor, keep your plan,' Obama insisted on Oct. 15, 2008.

But two years after signing the Patient Protection and Affordable Care Act into law, Obama gave many...

"Americans who feel overtaxed already are in store for a shocker: Obamacare will add 17 new taxes or penalties for a whopping cost of $502 billion over its first 10 years."

"Many people are still unsure what the coming health insurance tax will cost them.

Business Insider's Henry Blodget detailed the costs earlier today... specifically in regards to what the 'penalty' is if you don't buy insurance (as mandated)."

"The Children's Health Insurance Program (CHIP, formerly the State Children's Health Insurance Program (SCHIP)) was created by the Balanced Budget Act of 1997, enacted Title XXI of the Social Security Act, and has allocated about $20 billion over 10 years to help states insure low-income children who are ineligible for Medicaid but cannot afford private insurance. States receive an enhanced...

Despite a few recent rulings declaring the Patient Protection and Affordable Care Act unconstitutional, Ian Millhiser insists that the Act is not outside constitutional bounds. Millhiser argues that Congress has power to tax, "regulate the...

"The Obama administration's decision requiring church-affiliated employers to cover birth control was bound to cause an uproar among Roman Catholics and members of other faiths, no matter their beliefs on contraception."

Setting the stage for a historic constitutional confrontation over federal power, the Supreme Court on Monday granted three separate cases on the constitutionality of the new federal health care law....

"An April Kaiser Family Foundation Tracking Poll found that only 51 percent of respondents believed they had enough information about how the law would affect them personally. However, when asked their opinion about specific provisions of the law -- 'the law will prohibit insurance companies from charging women higher premiums than men' -- typically a strong majority approved. When voters...

"The biggest legal threat to the White House's birth control mandate could come from a decades-old law that was championed by liberal Democrats, according to legal experts."

This piece provides an interesting analysis on the unintended consequences of the individual mandate. Goodman discusses the problem of "free riders" and then shows how the individual mandate could actually encourage "free riders" rather than eliminate them. Furthermore, Goodman explains the flaws with the current system and then briefly describes a...

"The American Medical Association lost 5 percent of its membership last year as the physician group faced fallout from its endorsement of Obamacare and refusal to retreat from the law's most controversial provisions."

Responding to a column by Peter Orszag in which he declared that Obamacare "is an essential element to keeping future health care costs down," Veronique de Rugy argues that "ObamaCare has nothing to do with cutting costs." Ms. de Rugy then uses a...

"When an Obamacare regulations goes into effect tomorrow, 47 million women will benefit from the guaranteed coverage of preventive services — including contraception coverage — without co-pays. The new rules will require most insurance plans to begin including the services at no additional cost at the next renewal date that falls on or after August 1, according to a news release from the...

"Five days ago, Democrats were cheering the selection of Paul Ryan as Mitt Romney's choice for Vice President. Democrats thought that Ryan's efforts at Medicare reform would terrify seniors (with their encouragement, of course), thereby handing the election to President Obama. Contrary to their expectations, however, it has been the Obama campaign that has been forced to defend its $716...

"A majority of voters still supports repeal of President Obama's national health care law and believes it will increase the federal deficit and the cost of health care."

This brief article reports on public opinion polling for Obamacare. From March 2010 to March 2011, public support for repeal of the Patient Protection and Affordable Care Act only dropped 1% (from 55% to 54%). However, as...

"The latest analysis of health care reform – out today from bean counters at Medicare – shows reform will raise health care spending slightly over the next 10 years, not reduce it as promised by President Obama. That won't make selling it on the stump any easier. Yet there's a glimmer of hope in the out years of the 10-year projection that the plan will begin to 'bend the cost curve.'"

"If the health care reform vote succeeds today, the $940 billion bill would be the biggest change to domestic policy in a generation. The rich and the health industry would pick up most of the tab."

"In February 2009, as the Obama administration was beginning to make its pitch for a major health care overhaul, then-White House budget director Peter Orszag made his closing pitch for the law at a summit in Washington: 'To my fellow budget hawks in this room and in the rest of the country, let me be very clear: health care reform is entitlement reform,' he said. 'The path of fiscal...

Commenting on the court battle over the constitutionality of Obamacare, Doug Bandow declares that "we all have much at stake in maintaining the Constitution's limits on federal power." Bandow uses this article to briefly discuss state vs. federal jurisdiction, while also...

"Well, Obamacare is now official, which means that a lot more people in the United States will have health insurance.

And it also means a lot more people will be paying more taxes.

(You didn't think Obamacare was free, did you?)"

"A pivotal moment in the health care debate came when the president went before Congress and said this: 'Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.'


"We're probably going to be talking about the Affordable Care Act a lot between now and November. So it's worth taking a look at what actually pays for the health-care law and what that means for the future of Medicare and other programs.

There are two broad ways that Congress paid for the health-care law: It cut into government spending and created provisions that raise revenue, giving...

"There are 600,000 physicians in America who care for the 48 million seniors on Medicare. Of the $716 billion that the Affordable Care Act cuts from the program over the next ten years, the largest chunk—$415 billion—comes from slashing Medicare's reimbursement rates to hospitals, nursing homes, and doctors. This significant reduction in fees is driving many doctors to stop accepting new...

This article offers a clear, concise description of the Medicare reimbursement process. Included in the piece is information regarding the cost the doctor charges, the patient's portion of the payment, and the amount that Medicare actually gives...

"President Obama's health care reform law, which expands preventative care and lets young people remain on their parents' health insurance plans well into their 20s, is a central part of his election year pitch to college students.

And perhaps nowhere are students more critical to the president's re-election chances than in North Carolina, a state jam-packed with colleges and...

In studying the House and Senate health care bills, Michael Cannon found that Obamacare would affect the wages of the poor as well as the wealthy. According to Cannon, the individual mandate would discourage hard work and economic progress. Cannon also notes that the...

Although Jonathan Turley believes that "strong arguments can be made for health care reform and the individual mandate," he also declares that "these are matters that should not be decided by mere fiat of Congress but rather by the courts." This...

"Ordinary people — not just a small fringe group of zealots — are really afraid today. They see the country they adore being attacked at all levels; they see their freedoms under assault, their life savings genuinely in jeopardy, an endlessly anemic economy, a longer period of sustained unemployment than we've experienced in a half-century and a national financial crisis, born of world-...

Describing the court decision in which Judge Roger Vinson struck down the individual mandate portion of Obamacare, Thomas Miller notes how the Obama administration's lawyers unintentionally backed themselves into a corner with their argument. Miller also describes the clear court...

"Are you having trouble finding a doctor who will see you? If not, give it another year and a half. A doctor shortage is on its way.

Most provisions of the Obama health law kick in on Jan. 1, 2014. Within the decade after that, an additional 30 million people are expected to acquire health plans—and if the economic studies are correct, they will try to double their use of the health-...

According to Julian Pecquet, "Maine is the first state to get a[n Obamacare] waiver. Three other states — New Hampshire, Nevada and Kentucky — have pending waiver...

"Many states are waiting for a Supreme Court decision or even the November election results, to see whether central elements of the new [Health Care] law might be overturned or repealed. But that will be too late to start work. By Jan. 1, 2013, the Obama administration will decide whether each state is ready to run its own exchange or whether the federal government should do the job instead...

"Sen. Marco Rubio (R-Fla.) introduced a bill on Monday that would override the Obama administration's new rule on birth control coverage and allow religious hospitals, universities, and other organizations that morally oppose contraception to refuse to cover it for their employees."

"Two years ago, when introducing then promptly enacting Obamacare, the president stated that healthcare law reform would not cost a penny over $1 trillion ($900 billion to be precise), and that it would not add 'one dime' to the debt. It appears that this estimate may have been slightly optimistic… by a factor of 1700%."

"If states choose to accept Obamacare's huge expansion of Medicaid, it would burden both federal and state budgets. States are already struggling to afford the program."

"Recently on 'Meet the Press,' Republican presidential candidate Mitt Romney raised eyebrows when he promised to keep portions of President Obama's health care law in place if elected. The two candidates will no doubt spar over how they'll deal with health reform in the debates, which kick off this month."

Comparing the single payer health care system to the Wizard of Oz, Bob Moffit suggests that "some in Congress want to make the Wizard even more powerful." Moffit demonstrates this assertion by describing the changes that Congress wanted to make to Medicare payments during the Summer of 2009. According to Moffit, these changes...

"Missouri voters on Tuesday overwhelmingly rejected a key provision of President Barack Obama's health care law, sending a clear message of discontent to Washington and Democrats less than 100 days before the midterm elections.

About 71 percent of Missouri voters backed a ballot measure, Proposition C, that would prohibit the...

"Obamacare has suffered a devastating blow. On Friday, the Eleventh Circuit Court of Appeals ruled that the individual mandate in President Barack Obama’s signature health care legislation is unconstitutional. With its ruling, the court affirmed the principle that the Constitution means what it says—Congress does not have unfettered power to force the American people to comply with any and all...

"Amid continued concern about errors by overworked medical residents, hospitals would be forced to curtail shifts and increase supervision of some doctors-in-training under proposed new guidelines for residency programs released Wednesday."

"The Congressional Budget Office has estimated that Obamacare will reduce the deficit, by coupling a multi-trillion-dollar expansion of federal health spending with cuts to Medicare and higher taxes. Now, a new study by a Medicare trustee suggests that the law will actually increase deficits, over the next ten years, by between $346 and $527 billion. Why do the trustee's numbers differ from...

"Obama signed the health care bill into law today, calling its historic expansion of insurance coverage 'reforms that generations of Americans have fought for and marched for and hungered to see.'

'Today, after almost a century of trying -- today, after over a year of debate -- today, after all the votes have been tallied, health insurance reform becomes law in the United States of...

This article describes how the implementation of Obamacare effects ethical and moral issues. Donovan specifically discusses the impacts of PPACA on abortion procedures and funding. Among other things, Obamacare "fails to adequately...

"Looking for some straight facts on Obamacare and its impact? Here are some of the most important numbers you need to know about President Obama's health law..."

As evidenced by lawsuits and other legal maneuvers, many legislators across the country are committed to repealing Obamacare. As Michael Cannon notes, however, many of these same, repeal-minded authorities are actually aiding and abetting the implementation of Obamacare...

"The Affordable Care Act (ObamaCare) has been knocked for its alleged unintended consequences. The bill's attracted speculation that workers will lose their health plans, college grads will stop looking for jobs, and even that fewer people will get married.

Those are just the effects related to insurance regulations. Less attention has been given to how hospitals and health systems...

"Negative signs abound for the medical community today, as the House Oversight Committee prepares to hear testimony on the impact of ObamaCare on doctors and patients. First, there's the recent Doctor Patient Medical Association poll, which found 90 percent of doctors say the medical system is on the wrong track and 83 percent are thinking about quitting...:


"Last March, I wrote a detailed piece on why Obamacare will dramatically increase the cost of insurance for young people. Yesterday, Louise Radnofsky of the Wall Street Journal reported that some colleges are dropping their student health plans for the new academic year, because the new law increases the cost of those plans by as much as 1,112 percent. And no, that's not a typo."

From time to time, I’ve posted Pollster.com’s trend estimate of all polls gauging public opinion on ObamaCare. It’s a great little tool. But recently, I noticed something.

"Thanks to Obamacare, the uninsured rate in the U.S. dropped in 2011 to 15.7 percent from 16.3 percent in 2010, and 1.4 million Americans have health insurance now who did not have coverage a year ago, according to data from the Census Bureau. 2011 was the first year in more than a decade in which the number of people with private health insurance remained steady."

"Last week, a new Congressional Budget Office (CBO) report updated the amount of money Obamacare robs out of Medicare from $500 billion to a whopping $716 billion between 2013 and 2022."

"The Supreme Court just upheld the Affordable Care Act as constitutional, affirming Congress' authority to require Americans to purchase health insurance coverage. It's no doubt an understatement to describe this as a huge victory for the law, and the Obama administration. The Affordable Care Act – after spending two years in legal limbo – now has the court's backing to move forward. That does not, however, mean the law has smooth sailing ahead. Many obstacles still stand in the law's way, ones that could derail its success nearly as much as an adverse legal ruling. Here's a rundown of what the law faces in coming months."

"President Obama's new mandate requiring all employers to purchase insurance coverage for their employees that includes abortion-inducing drugs, sterilization and contraception is an outrage, of course. But what kind of outrage is it? Most of the public outcry has understandably centered around the mandate's assault on religious liberty."

"Catholic institutions filed a series of lawsuits yesterday seeking to vindicate their rights under the First Amendment and the Religious Freedom Restoration Act. At issue is the regulation mandating that all employer-provided insurance policies cover birth control, including sterilization procedures and abortifacient drugs, in violation of church teachings."

According to Warner Huston, "111 companies and organizations were granted waivers by Obama’s Dept. of Health and Human Services so that they could get out of having to comply with Obamacare and unions were...

According to Robert Moffit, "[n]o class of American professionals will be more negatively impacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act than physicians." Moffit goes on to say that "physicians will...

According to Robert Moffit, senior citizens will especially experience an increased burden through the changes made to Medicare under the PPACA. Moffit lists increased taxes, funding cuts, and fewer doctors as some of the different changes...

"In 1850, the French economist Frederic Bastiat wrote 'That Which Is Seen and That Which Is Not Seen,' in which he noted that, while politicians liked to trumpet the visible benefits of their largess, there were often unseen costs and consequences that resulted from those policies.

It is a lesson that politicians should heed today.

Take, for example, Obamacare. The president...

"In anticipation of the Supreme Court's Obamacare decision, it is important to remember that the constitutionality of the individual mandate isn't the only problem with the law. Here's a list of Obamacare's five most destructive impacts on America's seniors."

Because of a quirk in ObamaCare, people who buy health insurance through a federally run exchange may not be eligible for premium subsidies.

This brief article offers several charts which detail the basic operating costs of a normal hospital. The charts give a breakdown of costs and include information regarding salaries, benefits, and other expenses that hospitals deal with.

This piece provides a brief look at the components of an individual mandate in regards to health care. According to this piece, "[o]ne impetus for individual mandates is to increase enrollment of younger, healthier people into insurance pools in order to...

"Private-sector job creation initially recovered from the recession at a normal rate, leading to predictions last year of a 'Recovery Summer.' Since April 2010, however, net private-sector job creation has stalled. Within two months of the passage of Obamacare, the job market stopped improving. This suggests that businesses are not exaggerating when they tell pollsters that the new health care...

According to Minnesota Rep. Michele Bachmann, Congress experienced a startling revelation about Obamacare in early 2011. In the words of Rep. Bachmann, "over $105 billion was hidden in the Obamacare legislation to fund the implementation of Obamacare."...

According to this piece, the court ruling that struck down the individual mandate central to the PPACA brings constitutional liberty and fiscal savings to the...

Americans want health care reform. They just do not want the top-down, centralized bureaucracy enacted under Obamacare. Congress should continue its efforts to fully repeal Obamacare.

According to this article, the provisions of Obamacare will greatly swell the ranks of those on Medicaid. Due to this fact, Kathryn Nix examines how an increase in Medicaid participants will...

"Lawmakers in South Dakota have proposed a bill that would require all adults to own guns, a measure intended as a protest against the individual mandate for health insurance included in President Barack Obama’s health reform law.

Adults over the age of 21 would have to buy a gun 'sufficient to provide for their ordinary self-...

In discussing the Senate portion of the PPACA, Robert Book notes that the bill "include[s] provisions that could put private health plans out of business." Book goes on to say that the bill would specifically create the following scenario:

  • "Give federal regulators the power to define minimum benefit packages;
  • Specify by law the...

This article reports on the Obama administration's response to the court ruling which determined that the individual mandate of Obamacare was unconstitutional. According to Millman, Obama officials argued that the decision would...

This piece gives a brief, three-page summary of the key aspects of the Patient Protection and Affordable Care Act. The PPACA specifies the following:

  • "Most individuals will be required to have health insurance beginning in 2014...

"A narrowly divided Supreme Court upheld President Obama's health care law Thursday in a complex opinion that gives the president a major election-year victory. The historic 5-4 decision will affect the way Americans receive and pay for their personal medical care in the future. It upholds the individual mandate that most Americans get health insurance or pay a penalty — and it was the penalty, or tax, that ultimately saved the law."

"The U.S. Supreme Court today voted to uphold the Affordable Care Act, refusing to overturn the unpopular law and sending the issue back to voters to decide in the upcoming presidential election."

"The Supreme Court's decision to uphold President Barack Obama's health care law follows a century of debate over what role the government should play in helping people in the United States afford medical care."

As the title suggests, Ezra Klein uses this piece to make a case for the necessity of the individual mandate. Klein declares, "Kill the individual mandate and you're probably killing the bill, too. The mandate is what keeps average premium costs low,...

In this piece, John Vinci explains the six types of waivers that companies and individuals are receiving under the new health care law. According to Vinci, "Obamacare waivers not only evidence a poorly conceived law, but the very...

"Since passage of the Affordable Care Act (ACA), the American Action Forum (AAF) has tracked the state of its regulatory implementation. To date, the ACA has imposed a total of $27.6 billion in new regulations – at least $20.4 billion in lifetime costs on private entities and $7.2 billion in increased burdens on state budgets. In this paper AAF examines how this $27.6 billion in new costs...

"Reducing hospital readmission rates has captured the imagination of U.S. policymakers because readmissions are common and costly and their rates vary — and at least in theory, a reasonable fraction of readmissions should be preventable. Policymakers therefore believe that reducing readmission rates represents a unique opportunity to simultaneously improve care and reduce costs. As part of the...

Commenting on the newly elected leaders of 2010 and their reform-minded approach to governing, Peter Orszag presents his beliefs on why the health care law should not be repealed. According to Orszag, the Obamacare law focused on "cost-effectiveness and...

This piece reports on a New York union's intention to stop covering the children of some of their members. The decision was made due to increasing costs, which the union partly attributes to the implementation of the Patient...

Commenting on Nancy Pelosi's statement on the need to pass the PPACA, Marguerite Higgins declares that her comment revealed the condescension the 111th Congress felt toward the American people. However,...

"But the justices found fault with part of the health-care law's expansion of Medicaid, a joint federal-state insurance program for the poor. The justices gave states the option of sitting out the law's Medicaid expansion without losing existing funding for the program."

This article reports on Speaker Nancy Pelosi's views on the constitutionality of Obamacare's individual mandate provision. When CNS News posed the constitutionality question, Speaker Pelosi responded, "Are you serious?" According to a Pelosi spokesperson, the Speaker responded...

"One of the primary goals of the Affordable Care Act (ACA), commonly referred to as Obamacare, is to reduce the number of uninsured residents. One key provision aimed at that objective is the expansion of Medicaid. The Supreme Court, however, dealt a serious blow to the Obamacare's Medicaid expansion by essentially making the expansion optional for states."

"DNC Chairwoman Debbie Wasserman Schultz described the Medicare reforms proposed by GOP Vice-Presidential nominee and House Budget Committee Chairman Paul Ryan (R-WI) as 'literally a death trap for seniors.' White House spokesman Jay Carney told reporters that Ryan's reforms would 'change Medicare as we know it.'

But it was Obamacare that already changed Medicare as we know it,...

"This week, the U.S. Supreme Court considers the case challenging the Obama administration health care plan's requirement that most Americans purchase a government-approved health insurance plan by 2014. The court should rule that this individual mandate is unconstitutional. To do otherwise would give Congress almost unlimited power."

"A recent survey by the Doctor Patient Medical Association Foundation reveals that 83 percent of physicians surveyed are thinking of quitting because of Obamacare, and 90 percent feel that the U.S. health care system is now heading in the wrong direction."

"Health care costs for a family of four rose again in 2011, with employees paying a much larger share of the rising expenses, according to a new industry report Wednesday.

American families who are insured through their jobs average health care costs of $19,393 this year, up 7.3%, or $1,319 from last year, according to independent actuarial and health care consulting firm Milliman Inc...

Chart or Graph

"The ACA's $27.6 billion in new regulations represent a cost floor, and not a ceiling to implement the ACA. Most private entities will feel these costs and $7.2 billion of the added regulatory burdens fall directly on state budgets."

"The first category, the cuts to government spending, accounts for $741 billion of the health law's financing. It's mostly changes to how the government pays the doctors and hospitals who provide care to Medicaid and Medicare patients. Here's how those changes break down, per the CBO...."

"The 2012 MMI cost is $20,728, an increase of $1,335, or 6.9% over 2011. The rate of increase is not as high as in the past, but the total dollar increase was still a record. This is the first year the average cost of healthcare for the typical American family of four has surpassed $20,000."

"Since 2002, average premiums for family coverage have increased 97% (Exhibit A)."

"The average price for a filled brand name prescription increased 17.7 percent to $268 (Figure 12)."

"As seen in Figure 6, the highest average prices paid to a facility were for surgical admissions ($29,858, an 8.5% rise from 2010) and medical admissions ($13,023, a 5.9% increase over 2010)."

"As seen in Figure 8, the highest average price paid for a visit was for outpatient surgery ($3,673, a 6.6% increase from 2010)."

"As seen in Figure 10, the highest average prices paid to a health professional were for anesthesia ($714, a 3.2% increase from 2010) and administered drugs ($396, an 11.1% increase from 2010)."

Hospitals must spend money to function and provide patient care. The main categories of expenses include salaries, supplies, depreciation, amortization, interest, and bad debt expenses.

This interactive chart details the cases challenging the Obamacare law, the date of their argument, the type of court argued in, and the parts of the Constitution that each argument was based on.

"In 2010, the CBO estimated that Obamacare's spending on new programs would amount to $929 billion from 2013-2019, and a ten-year cost of $944 billion. Those figures increased to $956 billion and $1,442 billion respectively in 2011, and $1,053 billion and $1,856 billion in 2012."

"In 2010, the CBO estimated that Obamacare's tax increases would amount to $626 billion from 2013-2019, and $631 billion over ten years. In 2011, the CBO estimated totals of $624 and $968 billion, respectively."

"In 2011, the dollars spent per capita were highest for professional procedures ($1,566), and lowest for prescriptions ($773). The 1.0 percent growth in spending on prescriptions was lower than the 2.4 percent growth for 2010 (Figure 2)."

An individual mandate will result in an increase in government spending of about 1–6 percent, as shown in Table 1. Because the subsidy cost is all borne by government, as the size of the subsidy increases, so will government spending.

We examined the public cost (subsidies plus Medicaid spending) of expanding coverage under an individual mandate. Table 2 shows the pattern we observed across all scenarios with a subsidy option. The government cost per newly insured falls as the income level at which people are eligible for a subsidy increases

This interactive chart lists the various Constitutional sections and amendments on which the Obamacare law has been challenged. Article 1 is used most frequently in the Obamacare cases.

"Contrary to their expectations, however, it has been the Obama campaign that has been forced to defend its $716 billion in cuts to the Medicare program, cuts that Mitt Romney promises to repeal. In the weeks ahead, those defenses won't hold up. Here's why."

"Overall, PPOs are by far the most common plan type, enrolling 56% of covered workers. Nineteen percent of covered workers are enrolled in an HDHP/SO, 16% in an HMO, 9% in a POS plan, and less than 1% in a conventional plan (Exhibit E)."

"The amount of spending on Medicare, Medicaid, Social Security and Obamacare subsidies will soar over the next 38 years, leaving future generations with an alarming debt burden."

The estimated effects of the Affordable Care Act on overall national health expenditures (NHE) are shown by the 'net total' curve in the ... [above] chart. In aggregate, we estimate that for calendar years 2010 through 2019, NHE would increase by $311 billion, or 0.9 percent, compared to prior law.

Figure 15 presents another way of viewing the effects of reform on family income. The figure shows family income under the case of no reform and with successful cost growth reduction of various degrees. The figure makes clear that family income will be substantially higher with reform than without.

"Four reputable research institutions have run the numbers and found that not only is Obama's claim false, but employees will be dropped from their current coverage by the millions. This week's chart outlines each of the four studies."

In the table, we show the expected total gains in life years that we estimate would result from the implementation of an individual mandate. The estimate is a function of the number of additional people with coverage, so the scenarios that produce the largest increases in coverage will also produce the largest increases in life years.

"Health care costs for a family of four have doubled in less than a decade from $9,235 in 2002 to over $19,000 in 2011."

"By 2017, the average enrollee will lose $3,714 in health care services per year, totaling $54.97 billion for all such beneficiaries. The benefit losses will vary widely by state from a low of $2,780 in Montana to a high of $5,092 in Louisiana. (See Map 2.)"

"Using Congressional Budget Office (CBO) data, the chart ... shows that the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 have left the cost curve of federal healthcare spending virtually unchanged over the next 25 years."

"Many people are still unsure what the coming health insurance tax will cost them. Business Insider's Henry Blodget detailed the costs earlier today... specifically in regards to what the 'penalty' is if you don't buy insurance (as mandated)."

"Historical and projected Medicaid expenditures for medical assistance payments and administration are shown in table 3."

The income statement (also referred to as the Profit and Loss Statement or Comparative Statement of Operations) focuses on performance over a designated period of time, usually one year. This statement provides important information about the profitability of a hospital, including information on how the hospital gets its money and how the hospital spends its money.

By establishing both an excise tax on high-value health plans and a minimum MLR, the bill creates an implicit maximum legal premium that insurers can charge.

"Women stand to gain numerous benefits under President Barack Obama's health reform law, the Affordable Care Act."

Beginning in 2014, employers must offer minimal essential coverage to full-time employees or pay a penalty. When this provision takes hold, 88% of surveyed employers are either definitely, or likely, to play by continuing to provide health benefit coverage.

The majority of employers anticipate that health care reform will increase their organization’s health benefit costs. In response, most say they plan to pass on the increase to employees (88%) or reduce health benefits and programs (74%) (Figure 4).

Table 4 shows the difference in health care subsidies to be given to cohabiting couples and similarly situated married couples under the Senate bill. The figures were calculated by subtracting the subsidy figures in Table 2 for married couples from the corresponding figures for cohabiting couples in Table 3.

"If states choose to accept Obamacare's huge expansion of Medicaid, it would burden both federal and state budgets. States are already struggling to afford the program."

Doctors may agree to limit what they charge patients to the Medicare-approved amount for the services they provide, or they may charge a higher amount. Those who do agree to accept Medicare's rates for services are said to 'accept assignment'.

"The ACA [Obamacare] includes a number of provisions that are expected to reduce Medicare spending. (See Appendix A [above chart] for the cost estimate for the major Medicare provisions in the ACA.)"

"Implementation of the Patient Protection and Affordable Care Act (ACA) of 2010 will have a major effect on Medicare spending and policy."

According to the Congressional Budget Office, the legislation would reduce the number of uninsured Americans by about 32 million people by 2019. ... Most of those gains in the number of insured will not occur until after 2014 when the mandates and subsidies kick in.

"A key factor that drove down the number of people without insurance — 48.6 million people last year compared to 50 million in 2010 — is a provision in the Affordable Care Act allowing young adults to remain on their parents' insurance plans up to age 26."

Despite denials from the Obama administration and Democrats in Congress, the [PPACA] legislation does cut Medicare—and it should. Medicare is facing unfunded liabilities of $50 to $100 trillion depending on the accounting measure used, making future benefit cuts both inevitable and desirable.

Last week, 53% favored repeal of the health care law. Support for repeal has ranged from a low of 50% to a high of 63% since Democrats in Congress passed it a year ago.

The bureaucracy of Obamacare.

"The latest Rasmussen Reports national telephone survey finds that 53% of Likely U.S. Voters favor repeal, while 43% are opposed. This includes 45% who Strongly Favor repeal of the health care measure and 33% who are Strongly Opposed."

"Based on IRS estimates approved by the Office of Information and Regulatory Affairs at the Office of Management and Budget, ObamaCare will take American job creators and families nearly 80 million hours to comply with. Over half of that will fall on small businesses."

To illustrate, [diagram one shows] .... what the trend estimate looks like incorporating all polls. As of this month, opposition leads support by 7.3 percent (45.3 percent opposed to ObamaCare vs. 38 percent in favor).

Each bill would require low- and middle-income Americans to pay an increasing percentage of their income toward health insurance. As a result, the 'mandate tax' creates marginal rates as high as 53 percent — and that's for people making just $15,000 per year.

Obamacare waivers only last for one year and are only available if the plan certifies that a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage. As of today, a total of 733 waivers have been granted for 2011.

Data for calendar year 2004 show the distribution of costs as a percentage of total operating costs as pictured [in chart 1]. The most significant changes in costs between calendar years 2002 and 2004 are reflected in the [second] table.

Anyone expecting to see major changes to the health care system in the next few months or years is liable to be disappointed. As Table 2 shows, the most heavily debated aspects, mandates, subsidies, and even most of the insurance reforms don’t begin until 2014 or later.

The Census Bureau recently published its latest statistics on health insurance for the 2008 calendar year. It estimated, for instance, that approximately 46 million individuals in the United States lacked health insurance during 2008. That translates into 15.4 percent of the population. … I’ve taken those census data and broken them out by age, as shown in Figure 1.

65% believed the Supreme Court would find the individual mandate constitutional.

A family policy will increase from today’s $6,328 to $15,200. If the bill hadn’t passed, it would only have increased to $13,100. ... Thus, this bill will cost a family buying their own health insurance an additional $2,100 per year in higher premiums (see Table 1).

Averaged across all levels of coinsurance, participants (including both adults and children) with cost sharing made one to two fewer physician visits annually and had 20 percent fewer hospitalizations than those with free care. Declines were similar for other types of services as well, including dental visits, prescriptions, and mental health treatment.

Averaged across all levels of coinsurance, participants (including both adults and children) with cost sharing made one to two fewer physician visits annually and had 20 percent fewer hospitalizations than those with free care. Declines were similar for other types of services as well, including dental visits, prescriptions, and mental health treatment.

The HIE was a large-scale, randomized experiment conducted between 1971 and 1982. For the study, RAND recruited 2,750 families encompassing more than 7,700 individuals, all of whom were under the age of 65. They were chosen from six sites across the United States to provide a regional and urban/rural balance.

"As in 2010, professional procedures performed by physician and nonphysician providers accounted for the largest share of expenditure in 2011 (Table 1 and Figure 1)."

"Overall, professional services made up 34.4 percent of total per capita spending, but 43.4 percent of out-of-pocket payments (Figure 1 and Figure 5)."

Figure 11 shows how the new health care law will add to the burden of future government spending. By 2050, the new law will push total government spending toward 50 percent of GDP. By the end of the century, federal government spending would become almost unfathomable, surpassing 80 percent of GDP.

"Twenty states will lose the equivalent of 300 full-­‐time employees' worth of work to filling out ACA regulatory red tape. (See Figure 3) Additionally, 27 states have a burden of over $300 million in new regulatory costs."

"This week's chart illustrates the new taxes and offers a year-by-year rundown of their annual costs. These taxes will pay for generous subsidies, an expansion of Medicare and new government spending."

"AAF examined the ten most expensive ACA regulations (see Figure 1)."

PPACA2 contains 18 separate tax increases that will cost taxpayers $503 billion between 2010 and 2019. ... Three major tax hikes make up nearly half of the new revenue raised by PPACA.

Within two months of Obamacare’s passing, the recovery stalled. Figure 1 shows net private-sector job creation from January 2009 onward.

As Figure 10 shows, adding the cost of the doc-fix, discretionary costs, and other costs that were not originally included in CBO’s score to the legislation brings the total cost over 10 years of actual operation to over $2.7 trillion.

CBO officially scored the bill as reducing the budget deficit by $138 billion over 10 years. Putting that in perspective, if true, it would amount to roughly 62 percent of the total deficit that the federal government incurred in February of 2010 alone.

This chart demonstrates the growth of government spending on health care since 1900.

Analysis Report White Paper

This report gives an extensive overview of the implementations and implications of the 2010 Health Care Act. Among other things, Tanner describes the PPACA’s effects on insurance plans and premiums, taxes and subsidies, Medicare plans, and the budget deficit.

The annual Milliman Medical Index (MMI) measures the total cost of healthcare for a typical family of four covered by a preferred provider plan (PPO). The 2012 MMI cost is $20,728, an increase of $1,335, or 6.9% over 2011. The rate of increase is not as high as in the past, but the total dollar increase was still a record.

This piece seeks to give a clear explanation of the expenses and profits of a hospital. Among other things, the authors describe the high overhead a hospital has and also how hospitals are often paid less than they charge.

With A Survey of America’s Physicians, The Physicians Foundation has endeavored to provide a 'state of the union' of the medical profession.

Among other things, the study seeks to determine how Obamacare's Individual Mandate will affect "spending," patient "health," and "waste" in the health care industry.

Michael Tanner declares that the health care law of 2010 "will fundamentally change nearly every aspect of health care, from insurance to the final delivery of care." Tanner then discusses the impacts of the health care law, some of which include increased taxes, premiums, and care rationing.

In this piece, Jonathan Gruber contends that those who wish to repeal the PPACA are severely misguided. In Gruber’s eyes, repeal would bring increased costs, deaths, and budget deficits, while keeping it would rein in runaway health care costs."

"This poll was a bipartisan collaboration between the American Action Forum and the Blue Dog Research Forum. It was designed to gather expert insight into the probable outcomes of the Supreme Court case involving the Affordable Care Act."

This paper discusses the constitutional implications of health care reform's individual mandate requirement. The authors discuss the "unprecedented nature of an individual mandate," and then describe various legal provisions under which the individual mandate could be upheld or struck down.

To provide current information about the nature of employer-sponsored health benefits, the Kaiser Family Foundation (Kaiser) and the Health Research & Educational Trust (HRET) conduct an annual national survey of nonfederal private and public employers with three or more workers. This is the fourteenth Kaiser/HRET survey and reflects health benefit information for 2012.

The Health Care Cost Institute's (HCCI) Health Care Cost and Utilization Report: 2011 tracks changes in health care prices, utilization, and spending on people younger than 65 covered by employer-sponsored private health insurance (ESI).

Critics have alleged that the health care reform bill set to be voted on by the House Sunday is a job killer. What's the reality? It could affect some businesses heavily but many others not at all.

"This survey of more than 650 mid- to senior-level benefit professionals provides a snapshot of how employers are responding to a host of health care reform challenges that have far-reaching implications for retention, recruitment, productivity, workforce planning, change management and every aspect of the evolving employer-employee deal."

This piece gives several examples of medical entrepreneurs who are providing their patients with better care for a lower cost while operating their practices and companies like a for-profit business.

As the Patient Protection and Affordable Care Act (ACA) nears its second birthday, the latest Kaiser Health Tracking Poll finds that public opinion on the law remains evenly split with sharp divisions along partisan lines, much as it has been since the law was passed.

In pondering the title question, Simon Lazarus determines that the individual mandate is definitely constitutional.

"The Affordable Care Act establishes a national framework for near-universal health coverage. Under the law, beginning in 2014, a new individual mandate will require most individuals to obtain coverage.

"This paper provides a detailed overview of Medicare spending and financing, beginning with a review of the factors contributing to the growth in Medicare spending, including the effects of the 2010 health reform law." At this point in time, projections suggest that the PPACA will decrease Medicare spending overall.

As the title implies, this piece gives a brief overview of Friedrich Hayek's economic principles and then relates them to the regulations imposed by the Patient Protection and Affordable Care Act.

According to Yelowitz, young adults are the largest uninsured age group, mainly because they are in good health and prefer to spend their money on other goods besides insurance. This piece then goes on to explain how insurance costs for young adults would drastically change with the implementation of Obamacare.

While President Obama continues traveling the U.S. heralding the passage of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, businesses across the U.S. are growing more and more discontent—and for good reason.

The hodgepodge of new taxes that have already or will soon take effect as a result of the Patient Protection and Affordable Care Act may not all show up in the income tax tables, but their huge cost is still very real. This cost will become most apparent in lost wages and international competitiveness, and it reduces middle- and low-income families' wages.

This piece finds Brian Blase offering a one year assessment of Obamacare. Blase reviews the many promises that politicians declared the PPACA would bring and concludes that many of them have fallen to pieces.

Doctor Patient Medical Association Foundation conducted a faxed survey of random doctors in May 2012.

The Patient Protection and Affordable Care Act substantially alters Medicare Advantage and, as a consequence, reduces the access of senior citizens and the disabled to quality health care by restricting and worsening the health care plan options available to them.

This paper offers an overview of Obamacare’s effects on Medicare. Among other things, the paper describes the implementation of the "Independent Payment Advisory Board," the relationship between prescription drugs and Medicare under PPACA, and the type of care Medicare patients will be eligible for under PPACA.

This report combines a variety of the Heritage Foundation’s WebMemo pieces on Obamacare. The anthology covers everything from the constitutionality of Obamacare, to the tax burden imposed by the law, to the financial effects Obamacare promises for employers, seniors, and young people.

"Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost?"

"After decades of evolution and experiment, the U.S. health care system has yet to solve a fundamental challenge: delivering quality health care to all Americans at an affordable price. In the coming years, new solutions will be explored and older ideas revisited. One idea that has returned to prominence is cost sharing...."

Although the new Obamacare law has been touted as a way to decrease the burden on small business owners, this paper demonstrates how the opposite tends to be more likely. According to Hadley Heath, the bureaucratic burden imposed by increased taxes and regulations could crush the American entrepreneurial spirit and future economic growth.

"If the Senate bill becomes law, saying 'I do' would cost some couples over $10,000 per year." This report provides important data and charts on the increased costs married couples could incur under Obamacare.

Canadians often misunderstand the true cost of our public health care system. This lack of understanding limits Canadians’ ability to assess whether they are receiving value for their tax dollars.

"During the nine-month period leading up to the passage of the Patient Protection and Affordable Care Act, Americans were subjected to more than $200 million worth of TV, radio, newsprint and Internet ads. Almost all of these — pro and the con — were pure propaganda."


"Amid intense public interest, Congress passed the Patient Protection and Affordable Care Act (ACA), which became effective March 23, 2010. The ACA sought to address the fact that millions of Americans had no health insurance, yet actively participated in the health care market, consuming health care services for which they did not pay.

The ACA contained a minimum coverage provision by...

"Arnold Kling of EconLog talks with EconTalk host Russ Roberts about the economics of health care and his book, A Crisis of Abundance: Rethinking How We Pay for Health Care. Kling discusses whether we get what we pay for when we spend money on...

In this podcast, Roberts and Cogan declare that rising health care costs have grown because people expect free care for their small infirmities. Cogan suggests that health care would not be so expensive if individuals were required to pay for the small...

In this podcast, Russ Roberts and Henry Aaron discuss the implications of a single-payer health care system. They also discuss whether or not administrative costs play a large role in driving up insurance and other health care costs.

"Arnold Kling of EconLog talks with EconTalk host Russ Roberts about the death of his father and the lessons to be learned for how hospitals treat patients and our health care system treats hospitals."

"Steven Lipstein, President and CEO of BJC HealthCare--a $3 billion hospital system in St. Louis, Missouri--talks with EconTalk host Russ Roberts about the economics of hospitals. They discuss pricing, the advantages and disadvantages of specialization in...

This podcast discusses the argument for states rights in the Obamacare dispute. According to Michael Cannon, a glitch in the Obamacare law could make the case against the law stronger.

As the title implies, this podcast discusses the many unfortunate regulations that are occurring with the implementation of the Patient Protection and Affordable Care Act. Ms. Turner also describes some of the unappetizing changes that Americans are experiencing in their health care plans under Obamacare.

According to Michael Tanner, many of the things opponents of health care reform predicted would happen with the passage of the PPACA are most certainly happening only one year later. Tanner describes several of these occurrences and...

This podcast discusses the Commerce Clause and Obamacare and whether or not the latter's individual mandate is constitutional. To paraphrase Robert Levy, this is the first time that the government has mandated the purchase of anything, and if they can do it in one place, they can do it anywhere.

On October 22, 2009, a CNS News reporter asked Speaker Pelosi about the constitutionality of the Patient Protection and Affordable Care Act. As this brief audio clip demonstrates, Speaker Pelosi condescendingly responded, "Are you serious?"

This podcast reports on the Supreme Court's decision to hear the Obamacare case. Iyla Shapiro discusses the potential outcomes this monumental court case could bring.

This podcast discusses some of the early lawsuits and rulings against the Obamacare law. Despite the rulings, some states are still attempting to implement the law in preparation for the 2014 deadline. Cannon subsequently makes the...

"Amid intense public interest, Congress passed the Patient Protection and Affordable Care Act (ACA), which became effective March 23, 2010. The ACA sought to address the fact that millions of Americans had no health insurance, yet actively participated in the health care market, consuming health care services for which they did not pay.

The ACA contained a minimum coverage provision by...

"Reason's Damon Root attended the pivotal second day of oral arguments before the Supreme Court on the Patient Protection and Affordable Care Act (ACA), which he described as a 'Constitutional Thunderdome.' The debate over the legality of the mandate to purchase insurance at the heart of ACA was, says Root, a rough-and-tumble colloquy about the 'the role of government in our lives' and 'what...

According to Reason TV's Nick Gillespie, the three reasons why Obamacare won't cut the deficit are "legislative trickery," "higher premiums," and "bad accounting." Overall, Gillespie argues that high costs are a regular "feature of government health care plans."

"Early in this blog, I wrote my Cliffs Notes Version of the Affordable Care Act. It is popular because it provides a big picture view of the law title by title. Since some prefer video to reading, we've created a short video of the Cliffs Notes Version. I want to reach as many as possible – it is important for people [to] understand the ACA is not 'all good” or 'all bad.' Maybe after people...

"States can require people to buy insurance for automobiles and health care. So why can't the federal government? According to Professor Elizabeth Price Foley, the U.S. Constitution gives the federal government limited and enumerated powers that confine it. The Constitution gives different powers to the states than it does to the federal government. Just because states have the power to...

"The 'Individual Mandate' section of the new healthcare reform bill introduces a paradigm shift in the role of the federal government. For the first time in American history, citizens will be forced to purchase something (in this case health insurance approved by the government) against their will or else pay a fine. Some legal scholars worry that this is an egregious form of constitutional...

The Fourth Annual Rosenkranz Debate was held on November 12, 2011, during The Federalist Society's 2011 National Lawyers Convention.

"America's health care system is at a crossroads, faced with rising costs, quality concerns, and a lack of patient control. Some blame market forces. But as Michael Cannon and Michael Tanner argue in their new book, Healthy Competition: What's Holding Back Health Care and How to Free It, many troubles can be traced directly to pervasive government influence: entitlements, tax laws, and costly...

"Are you aware that over 1,000 temporary healthcare reform waivers have been granted by the Administration to organizations around the country? The reason: they can't meet the limited annual coverage without significantly increasing premiums or decreasing access to benefits. That leaves us with some looming questions: What about us, the individuals? What about the people who can't afford to be...

"Johan Norberg, author of In Defense of Global Capitalism, sits down with reason.tv's Michael C. Moynihan to sort out the myths of the Sweden's welfare state, health services, tax rates, and its status as the 'most successful society the world has ever known.'

"Senator Max Baucs addresses what Obamacare really is about after the Democrats passed the 'fix' bill and sent it back to the House."

"Down on the boardwalk, we interview a few young Americans to find out what they know about the Constitution of the United States. Can you answer the questions? Does it matter?"

"We ask moms on the street what they know about the Constitution. Can you answer the questions? Does it matter?"

"The 'Individual Mandate' section of the new healthcare reform bill introduces a paradigm shift in the role of the federal government. For the first time in American history, citizens will be forced to purchase something (in this case health insurance approved by the government) against their will or else pay a fine. Some legal scholars worry that this is an egregious form of constitutional...

"We all agree the health care system is in need of reform. That's not the issue. The debate is really what kind of reform is needed. There are those rooting for nationalizing health care - Obama Care. What's that you ask? Obama's idea of reform is a government takeover of the health care system. One of the most popular forms of government takeover is the 'Massachusetts Model.' Those of us...

"Reason's Damon Root was in attendance for the third and final day of oral arguments before the Supreme Court on the Patient Protection and Affordable Care Act (ACA), which focused primarily on the issue of severability, which brings into question whether the individual mandate be excised from the law, or if the law in its totality must be struck down.

Now that the case is in the hands...

"The Patient Protection and Affordable Care Act (Obamacare) has set forth an individual mandate that requires all Americans to have health insurance. The justification for the law rests on the idea developed since the New Deal in the 1930s that any economic activity an individual engages in could impact the national economy and therefore can be regulated by the Federal Government based on its...

"Reason's Damon Root got a coveted seat for the Supreme Court oral arguments on the Patient Protection and Affordable Care Act (ACA). Day one of this epic judicial showdown focused primarily on whether or not the individual mandate constitutes a tax. If the justices rule that the penalties associated with the mandate should be considered a tax, the challengers to ACA would have to wait until...

This brief and amusing video describes Obamacare as a medication with millions of negative side effects.

"In 2006, when Indiana small-business owner Scott Womack purchased a development agreement to expand his IHOP franchise into Ohio, he had no idea Congress would pass a massive overhaul of the health care system four years later. Today, one year after that legislative overhaul became law, Womack is very aware of Obamacare -- and of its effects on his plans for growth."

"Dr. Martha Boone, an Atlanta urologist, explains the consequences of the new health care law. Because of her fears about Obamacare, Boone moved to a less-expensive office so she could avoid dropping Medicare patients or laying off an employee."

"Obamacare expands government-controlled health care -- passing the cost to future generations of taxpayers -- and weakens families' choice of coverage. Larry Patterson describes the impact Obamacare will have on his family and the concerns he has with the new law."

"It's official, trillion is the new billion. No longer is government spending talked about in terms of a mere ten digits. With the recent flurry of government spending, we are going to need another three zeros to make sense of it all. One trillion dollars is a number that few people can comprehend, let alone your standard nine digit calculator. So what does one trillion dollars look like?"

This video offers the President's and Vice President's remarks at the signing of the Patient Protection and Affordable Care Act in March of 2010. Lauded as a historic day, the signing was received with jubilation by the many who labored endlessly to bring the President's healthcare reform to pass.

"After unveiling the Senate health insurance bill to Congress, Nevada Senator Harry Reid hailed the legislation's efforts to 'save lives, save money and save Medicare.' Without adding a dime to the deficit, the Patient Protection and Affordable Care Act will make it easier for businesses to provide working Nevadans with health insurance, while strengthening our...

In March of 2011, Representative Michele Bachmann revealed that the PPACA had a hidden implementation fund of 105 billion dollars. In this interview, Bachmann argues that it is necessary to cut funding for this provision immediately in light of national budgetary problems.

This five second clip presents Speaker Pelosi's famous remark about the Patient Protection and Affordable Care Act, namely, "we have to pass the bill so that you can find out what is in it."

"On the Senate floor today, Ranking Member Sessions announced that a new Budget Committee analysis has found that the long-term, unfunded liabilities associated with President Obama's health care law will reach $17 trillion. The Committee's analysis is based on the Obama Administration's own numbers as well as those from the Congressional Budget Office. It is a modest, conservative estimate...

This video gives the Obama administration's opinion on how much Obamacare repeal would cost the country. Ms. Cutter explains the savings families of different income levels will enjoy under the law and also describes how many jobs could be lost if the healthcare reform law is not implemented as planned.

This video provides clips of President Obama's address to Congress on his health care plan. Among other things, the President promised the American people that they could keep their insurance if they liked it and that his plan would not add more to the deficit.

"The Oregon Health Insurance Experiment is the first study ever to measure the effects of health insurance by randomly assigning subjects to receive Medicaid coverage or no coverage. At this forum, lead investigator Katherine Baicker will present the Oregon Health Insurance Experiment's first set of results and discuss further data that this revolutionary experiment will produce. The panelists...

"In a complex decision, the Supreme Court has ruled that the individual mandate component of the Patient Protection and Affordable Care Act is constitutional under Congress's taxing power. What is left of the idea that the Constitution creates a government of limited powers? What does this case-of-the-century mean for both the Constitution and our health care system and what are next steps for...

"In a complex decision, the Supreme Court has ruled that the individual mandate component of the Patient Protection and Affordable Care Act is constitutional under Congress's taxing power. What is left of the idea that the Constitution creates a government of limited powers? What does this case-of-the-century mean for both the Constitution and our health care system and what are next steps for...

"In a complex decision, the Supreme Court has ruled that the individual mandate component of the Patient Protection and Affordable Care Act is constitutional under Congress's taxing power. What is left of the idea that the Constitution creates a government of limited powers? What does this case-of-the-century mean for both the Constitution and our health care system and what are next steps for...

"One year after the passage of major health care legislation, Harvard economist Jeff Miron says more reform is still needed. Dr. Miron gives his top 3 policy proposals for fixing the U.S. health care system: 1) Throw away the notion that health care is a right; 2) Repeal Obamacare; and 3) Phase out Medicare."

According to this video, one of the leading challenges of Obamacare has to do with the individual mandate and its relation to the Commerce Clause in the Constitution. This video describes the background of the Commerce Clause and whether or not the Obamacare law violates the Clause.

"At its one-year anniversary, Obamacare continues to frustrate and confuse the medical community and American public at large. In fact, recent surveys show doctors are less optimistic about the future of medicine, with some considering exiting the medical profession entirely. Heritage's medical panel will detail their firsthand experiences with Obamacare and their...

"Does the fate of a federal government with limited powers rest in the hands of Supreme Court Justice Antonin Scalia? And if so, will he rule against broad federal powers (as he did in the Gonzales case) or in favor of the feds' right to regulate just about anything (as he did in the Raich case)?"

Primary Document

This piece presents a large variety of information on the services and costs of Medicaid, especially in regards to the recently enacted PPACA. "The Affordable Care Act will have a substantial effect on Medicaid trends over the next 10 years and beyond. In terms of the magnitude of changes to the program’s projected expenditures and enrollment, it...

"The American Medical Association has long supported health insurance coverage for all, and we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy."

"FOR AN ACT ENTITLED, An Act to provide for an individual mandate to adult citizens to provide for the self defense of themselves and others.


Section 1. Not later than January 1, 2012, each citizen residing in the state of South...

A leading precursor to the Patient Protection and Affordable Care Act, Senator Max Baucus' paper on health care reform called for "legislation that achieves coverage for every American while also addressing the underlying problems in our health system." According to Baucus, "this Call to Action … is not intended to be a legislative proposal. Nor is...

“In this case, the Commonwealth of Virginia …, through its Attorney General, challenges the constitutionality of the pivotal enforcement mechanism of the health care scheme adopted by Congress in the Patient Protection...

Updated in May of 2010, this document contains the full text of the health care law popularly known as Obamacare and signed into law on March 23, 2010 by President Barack Obama.

The oral argument for the first day of Supreme Court hearings on the Obamacare law.

The transcript from the first day of oral arguments before the Supreme Court on the Obamacare law.

The transcript of the second day of oral arguments before the Supreme Court on the Obamacare law.

This hearing concerned the Anti-Injunction Act issue of the Patient Protection and Affordable Care Act cases and whether it applies to the individual mandate or not.

This hearing concerned the Anti-Injunction Act issue of the Patient Protection and Affordable Care Act cases and whether it applies to the individual mandate or not.

The matter of abortion was one of the concerns raised by opponents of the PPACA. In light of these concerns, President Obama released this executive order, which declared that "it is necessary...

"Milliman, Inc. (Milliman) was retained by the Mississippi Division of Medicaid (DOM) to perform analysis related to changes to the Medicaid program resulting from federal healthcare reform. This report documents the results of our financial impact review of the Patient Protection and Affordable Care Act as amended by H.R. 4872, the Reconciliation Act of 2010. Our results calculate Mississippi...

In my message to the Congress on November 19, 1945, I said that every American should have the right to adequate medical care and to adequate protection from the economic threat of sickness.

After being asked about the constitutionality of the individual mandate requirement in the Obamacare bill, Speaker Nancy Pelosi's office issued this press release. According to the press release, the...

Using an anecdote to describe how important Obamacare health coverage is to Americans with pre-existing conditions, the U.S. Attorney General and Health and Human Services Secretary bemoan a court ruling that declared the individual...

Heavily promoted by the Clinton administration in the early nineties, the Health Security Act was a precursor to the Patient Protection and Affordable Care Act. This Act was cited as "A BILL To ensure individual and family security through health...

This document explains the components of the increasingly growing waiver system under Obamacare. The document includes a chart listing the 729 organizations that had been approved for waivers as of January 26, 2011. Among the organizations...

"As you requested, the Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have estimated the direct spending and revenue effects of H.R. 6079, the Repeal of Obamacare Act, as passed by the House of Representatives on July 11, 2012. This estimate reflects the spending and revenue projections in CBO's March 2012 baseline as adjusted to take into account the...

"The percentage of people without health insurance coverage decreased in 2011 to 15.7 percent from 16.3 percent in 2010. The number of uninsured also decreased to 48.6 million in 2011 from 50.0 million in 2010."

This article lists the names of lawsuits challenging the Obamacare law and gives a brief description about each case.

Although the Patient Protection and Affordable Care Act had many opponents, it also had many supporters. The American Medical Association was one of the latter, and this letter from the AMA's president expresses that support by stating the...

Before holding the final House vote which would eventually pass Obamacare, House Speaker Nancy Pelosi gave this speech. Pelosi urged her colleagues to vote in favor of the PPACA, noting the historical nature of the vote and declaring that “[t]he best action that we can take...

The U.S. Supreme Court's highly anticipated decision which upheld the Affordable Care Act.

"The Patient Protection and Affordable Health Care act signed into law by President Obama in late March is a complicated bill that overhauls the nation's health care system over a period of five years.

It sometimes is mentioned in the same breath with the United Kingdom's National Health Service Act of 1946 which set up that country's government-run health-care system.

But that...

"According to former Internal Revenue Service (IRS) Commissioner Fred Goldberg, and supported by the Obama Administration's own figures, ObamaCare '...in its current form will be a needless administrative and compliance quagmire for millions of Americans.'

Based on IRS estimates approved by the Office of Information and Regulatory Affairs at the Office of Management and Budget,...

This brief document lays out the fines that will be expected from those who refuse to buy health insurance under the PPACA. According to this document, “[t]hat penalty will be the greater of a flat dollar amount per person that rises to $695 in 2016 and is indexed by...

In a speech before the National Association of Counties, Speaker Nancy Pelosi discussed the economic need for more jobs and health care reform. Pelosi emphasized the need to insure Americans with pre-existing...

The Anti-Injunction Act declares that "no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person, whether or not such person is the person against whom such tax was assessed." In other words, pay first, sue later.

After an extensive debate in Congress, the Patient Protection and Affordable Care Act passed both the House and Senate. The transcript of the presidential signing of the PPACA legislation reflects the...

In an address to the American Medical Association, President Obama discussed some of the many problems with the American health care system. The President then went on to lay out his plan for health care reform,...

Marking the three month anniversary of the signing of PPACA, President Obama addressed the subject with a group of guests at the White House. The President focused his remarks on the positive outcomes that the PPACA was beginning to provide for Americans, while also condemning those who urge the repeal of Obamacare.

In this short speech, President Obama delightedly recognized the support and endorsement given to the Patient Protection and Affordable Care Act by the AARP and the AMA. President Obama concluded by "urg[ing] Congress to listen to...

"This report first analyzes the authority of Congress to enact the minimum essential coverage requirement contained in PPACA, as well as how a court might analyze this provision if challenged based on various provisions of the Fifth and Tenth Amendments. This report discusses whether there must be exceptions to a requirement to purchase health insurance based on...

In January 2011, U.S. District Judge Roger Vinson declared that "'The Patient Protection and Affordable Care Act' [is] unconstitutional." Judge Vinson's decision was carefully thought out and related to the Constitutional "Commerce Clause." Vinson also made an...

In August of 2011, the Eleventh Circuit Court of Appeals declared that parts of the PPACA were unconstitutional. This decision addresses the constitutionality of the Individual Mandate portion of Obamacare, as well as the difference between a tax and a penalty in relation to the PPACA's implementation.

"The federal government has no constitutional authority to dictate how Americans shall pay for their medical care. It has no right to force them to turn over their earnings for the profit of private insurers or for the 'public use,' such as providing 'free' services that a federal agency dictates people should have."

Appellants, four United States citizens and federal taxpayers, seek declaratory and injunctive relief to prevent various U.S. Government officials and agencies from enforcing the minimum essential coverage provisions.

During the debate preceding and following the passage of the Patient Protection and Affordable Care Act, many opponents of the PPACA pointed to a CBO report that emerged during the health care proposals under President Clinton. This report noted the "unprecedented" nature of forcing American citizens to buy health insurance. Opponents of the PPACA...

"The Council of Economic Advisers (CEA) has undertaken a comprehensive analysis of the economic impacts of health care reform. The report provides an overview of current economic impacts of health care in the United States and a forecast of where we...

In this testimony before the House Budget Committee, Richard Foster describes some of the costs and implications the PPACA could have on Medicare and other health expenditures. In regards to these issues, Foster declares the following:


Following inquiries by Senator Tom Coburn, "[t]his memorandum responds to ... [Coburn's] request for information regarding the penalty imposed on those who fail to maintain minimum essential health benefits coverage...