6. Repaying subsidies: It’s going to be very important to accurately indicate annual income on one’s insurance application. Those who understate income, either because their situation changes or they reported inaccurate information, and therefore get a larger subsidy than they are entitled to will be required to repay the excess, possibly amounting to thousands of dollars.
7. Public health-care costs are going to explode. The Centers for Medicare and Medicaid Services, where actuaries make calculations about the trajectory of public health expenditures, have this to say:
In 2014 the implementation of provisions of the Affordable Care Act related to major coverage expansions is expected to accelerate health spending growth to 6.1 percent. Through the remainder of the projection period . . . this rate of growth is sustained as a result of improved economic conditions and an aging population’s increased demand for health care.
Following this 2014 cliff, they expect that — under optimistic assumptions about the law’s cost-saving provisions — Obamacare will modestly increase the rate of health-care cost inflation, which is set to wreck the federal budget already.
So much for the president’s promise to “bend the cost curve.” It’s bending the wrong way.
8. More jobs lost: The Obama administration delayed for a year reporting requirements for the mandate that companies provide health insurance for their employees. But with those provisions coming into effect in 2015, employers will continue to restructure their businesses to stay under 50 employees and push workers under 30 hours a week to avoid the hefty fines that will be used to enforce this regulation. Andrew Puzder, chief executive of CKE Restaurants, wrote in The Wall Street Journal that “the evidence that Obamacare is having a negative impact on hiring is unequivocal, abundant and consistent with common sense.” Job creation will continue to suffer.
9. Identity theft and fraud will explode: Tens of thousands of “navigators,” “assisters,” and other agents are being hired, generally by nonprofit organizations, to help people apply. They will be gathering personal information, such as one’s Social Security number, address, income, employer’s name and address, children’s names and birthdates, and health habits, to find out if you qualify for Obamacare subsidies. Others are going door-to-door to get people enrolled, and there is no easy way of determining if the person at your door is legitimate. While these aides do receive some training, they’re not professionally licensed and don’t go through the background checks required of insurance agents and brokers. The risks of potential identity theft are very real, and 13 attorneys general have expressed deep concerns about the security of the exchanges’ information. When this starts happening, it will generate a new wave of negative coverage of the law.
10. Federal-exchange subsidies eliminated? A number of lawsuits are making their way through the courts that could further challenge key aspects of the law. Suits in Oklahoma, the District of Columbia, Indiana, and Virginia federal courts are challenging the legality of distributing health-insurance subsidies through the exchanges created by the federal government, correctly contending that the law explicitly says the subsidies are available only to people enrolled in exchanges created by the states. That could mean that people in 34 states would not be eligible for Obamacare subsidies (even if they were to slog their way through the complex application process).
If you thought Healthcare.gov was bad, just wait.
— Grace-Marie Turner is president of the Galen Institute.