The Obama administration maintains that its Affordable Care Act is a complex construct that's endangered if the Supreme Court finds its central feature -- the requirement that all Americans buy health insurance -- unconstitutional. It's certainly true that eliminating the "individual mandate" will immediately expose the plan as unworkable. It can only succeed by creating a broad, universal insurance pool that collects big premiums from the young and healthy. If the young and healthy aren't required to sign on, they won't. Hence, the pools won't be remotely large enough to pay for the older, sicker folks who get the best deal, and are bound to flock to the state exchanges.

In reality, the reform plan's success doesn't depend on the Supreme Court's decision at all. Its faulty design virtually guarantees that all the things the administration warns will happen if it loses will happen anyway. Even if it stands, the legislation will spawn insurance plans crowded with high-cost folks, driving premiums higher, hobbling competition as carriers abandon the exchanges, and leaving tens of millions of Americans uninsured.

When Congress created Medicare Part D, the created two benefits for seniors. The first is a basic benefit where seniors pay 25% of their annual drug costs up to $2,830 (in 2010) and the government pays the rest. The second is a catastrophic benefit where the government will pay 95% of a senior's drug cost above $6,440. In the middle (from $2,830 to $6,440), seniors are responsible for 100% of the costs. The benefit to taxpayers is that the gap between the two benefit programs (critics call it the "donut hole") is that it incentivizes seniors to opt for generics to avoid the so-called donut hole. ObamaCare eliminates the donut hole and in turn one of the most important market-based aspects of Part D.

For more on this issue, go here.

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President Obama and Democrats in Congress pushed for cuts to Medicare Advantage to "pay for" ObamaCare. These cuts will have a devastating impact on Senior's ability to access care under the Medicare program. It has recently been discovered that the Administration is now using a slush fund to temporarily stave off the impact of these devastating Medicare Advantage cuts - at least until the election.

According to the Washington Examiner:

"According to a Government Accountability Office report published yesterday, the administration has been doling out cash from an $8 billion slush fund to temporarily cushion the blow from these cuts. The pain will come later, presumably after his re-election."

You can read the full commentary from the Examiner here.

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Are there many ways that a state could shield businesses in their state from an onerous, job killing tax penalty? In most cases - no. But in the case of ObamaCare the answer is a definitive "yes!!!"

ObamaCare seeks to have states set up insurance exchanges or government controlled "markets" whereby federal subsidies are dolled out so that people can buy heavily regulated, government approved health insurance. According to this article from The Wall Street Journal, if a state establishes an exchange, ObamaCare allows the subsidies to be given out (see Section 1311). If a state refuses to set up an exchange, the federal government will do so but ObamaCare does not permit any subsidies for people who access the federal exchanges (see Section 1321). 

So, a state that takes a pass on establishing an exchange (as many states have chosen to do) is effectively telling the feds, "we aren't going to spend state tax dollars to do your dirty work - have at it." But here is where a state that decides to take a pass can really benefit that state's economy. Under ObamaCare, if someone receives an exchange subsidy, their employer is subject to a penalty under ObamaCare but if no employees receive a subsidy employers are not subject to the penalty. Get it? The bottom line is that states can protect job creators from onerous federal taxes if they refuse to create and set up an ObamaCare insurance exchange. That is a significant incentive for states to protect their economy and jobs. The alternative is to create an exchange, letting the penalty kick in, resulting in fewer businesses and fewer jobs which will create a double-whammy for state taxpayers. Taxpayer will have to foot the bill to deal with the further strain on a state's social safety net resulting from higher unemployment and would end up footing the bill to finance a system to hand out federal bennies.  A bad deal all around for states, employers, employees and taxpayers.

Read more about this here.

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