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Obamacare: The Biggest Insurance Scam in History
Wednesday, 30 October 2013 10:21
By Kevin Zeese and Margaret Flowers , Truthout

The Affordable Care Act (ACA), also called "Obamacare," may be the biggest insurance scam in history. The industries that profit from our current health care system wrote the legislation, heavily influenced the regulations and have received waivers exempting them from provisions in the law. This has all been done to protect and enhance their profits.

In the meantime, the health care crisis continues. Fewer people, even those with health insurance, can afford the health care they need because of out-of-pocket costs. The ACA continues that trend by pushing skimpy health plans with low coverage and restricted networks.

This is what happens in a market-based system of health care. People get only the amount of health care they can afford, rather than what they need. The ACA takes our failed market-based system to a whole new level by forcing the uninsured to purchase private health plans and using the government to sell and subsidize them.

Sadly, most Americans are being manipulated into supporting the ACA and do not even know they are being bamboozled. That is how scams work. Even after the con is completed, victims do not know they have been manipulated and ripped off. They may even feel good about being scammed, thinking they made a deal when they really had their bank accounts picked. But it is the insurance companies that are the realizing windfall profits from the Obamacare con even as it falters.

The mass media is focused on the technical problems with getting the insurance exchanges up and running. These problems result from the complexity of the law and outsourcing of services to corporations that are often more costly and less effective than government. In comparison, in 1965 when Medicare started, everyone 65 and over was enrolled within six months - using index cards.

If all US residents were in one plan, Medicare for all, rather than the ACA's tiered system that institutionalizes the class divides in the United States, not only would the health system be fairer and improve health outcomes, but it would be less bureaucratic, less costly and easier to implement. The Medicare-for-all approach considers health care to be a public good, something that all people need, like schools, roads and fire departments.

Rather than being distracted by the problems of the exchanges, the more pressing issue is whether we want to continue using a market-based approach to health care or whether we want to join the other industrialized nations in treating health care as a public good. This conversation is difficult to have in the current environment of falsehoods, exaggerations and misleading statements coming from both partisan directions, echoed by their media supporters and nonprofit organizations.

Of course, the Republicans attack Obamacare for partisan reasons. And they are often blatantly dishonest in their criticism. Their foundational claim, calling Obamacare socialized medicine, is the opposite of reality. And, the Obama administration and its allies in the nonprofit world also have their fair share of falsehoods about the ACA. We will describe these farther below.

A Primed Public

In reality, the US health care system is the worst of the wealthy nations. We spend the most per person, have the lowest percentage of our population covered and have poor health outcomes. Forty-five thousand adults die each year merely because they do not have insurance, and 84,000 Americans die each year of preventable illnesses that would not die in the French, Japanese or Australian health systems.

Even those with insurance find it to be inadequate when they get seriously ill. Medical costs and illness are the greatest reasons for bankruptcy, and insurance does not prevent financial ruin. Every family is touched by the failures of US health care.

The Institute of Medicine issued a report in 2013, US Health in International Perspective, that documents the failure of the US health care system. In summary: "Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, 'peer' countries."

The health care crisis had grown to such proportions that by the 2008 election it could not be ignored. It was a major topic of the presidential campaigns. The health industries knew this and invested heavily in the candidates. Candidate Barack Obama overwhelmingly received more in donations from health care-related industries than any of the other candidates.

The public was ready for health care reform. Knowing that the majority of the public supports a Medicare-for-all system, it was going to take serious planning to silence that majority and enact a law that protected the interests of the health industries.

Obamacare: The Insurance Scam

A scam is a fraudulent operation designed to make money. A scam unfolds over time with a team of swindlers seeking to rob the victim without the victim ever knowing they have been scammed.

In Confessions of a Confidence Man, Edward H. Smith lists the "six definite steps or stages of growth in every finely balanced and well-conceived confidence game." Let's go through these six steps and see how the process of selling the ACA to the public fits.

1. Develop the Foundation

The foundation of a scam is the preparation done ahead of time to set up the scheme. In the case of the ACA, the foundation began with the health law passed by Massachusetts in 2006. The template was created by Stephen Butler of the Heritage Foundation, a conservative think tank. The law was passed under a Republican governor, Mitt Romney.

The next task was to sell this idea to Democrats. The Robert Wood Johnson foundation gave a major assist when it made large grants to state health reform groups in 2008 to promote Massachusetts-style reform in their states, called the "public-private partnership" model.

To further sell the ACA, Roger Hickey, a longtime Medicare-for-all advocate of the Campaign for America's Future (closely allied with the Democratic Party), took an idea from Jacob Hacker to create a new public insurance modeled after Medicare to 'compete' with private insurance. Hickey sold the model to progressive groups, and Hacker's proposal was used by the Obama campaign.

In July, 2008, Hickey and others rallied progressive groups to create a new coalition, Health Care for America Now, which received tens of millions of dollars to build grass-roots support for the ACA. The name was similar enough to the longtime Medicare-for-all organization, Healthcare-Now, to cause confusion.

2. The Approach

The approach is the way that the con artist gets in touch with the victim. The vehicle for the ACA con was the tech-savvy political campaign of Barack Obama. The candidate promised hope and change. Obama, who had supported single payer before running for president, was able to point to all of the problems in the US health care system and excite people with the potential of a new leader who understood the crisis and would fix it.

After his election, the campaign organized Health Care House Parties in December 2008. People were encouraged to invite friends and neighbors to their homes, and the Obama transition team provided the materials. The booklet that was used was tightly scripted to build support for the ACA rather than actually elicit citizen input on what kind of health system was desired.

3. The Buildup

In this stage, the victim is excited about the prospect and is filled with anticipation so their judgment is warped and caution is thrown away, setting them up to fall for the scam.

Throughout the winter and spring of 2009, the Obama administration gave the appearance of bringing all of the "stakeholders" together to work for health reform. The president held a White House Health Summit in March 2009, which included representatives from health insurance corporations, hospitals and pharmaceutical companies. The only groups that were not included, until there was a threat of protest, were those who advocate for Medicare for all. The single-payer advocates did not speak, but the insurance spokesperson opened and closed the White House summit.

Throughout the spring, the president and allies reassured the public that if they liked their health insurance, they could keep it; that insurance would be made more affordable (not that health care would be more affordable); and that reform would aim for universal coverage.

4. The Convincer

The convincer for many who supported real health reform was "the Public Option." The idea was that the law would force the uninsured to purchase insurance but would include the choice of a public health insurance plan. The public was told that this option would be more cost-effective than private insurance and, thus, less expensive, which would make it more attractive.

Many were convinced that a public option would become a Medicare-for-all system, that it was a "back door" to single payer. They were told that going straight to a single-payer health care system would be too difficult and that the public option was a first step. Health Care for America Now organized grass-roots groups to put their energy into fighting for a public option, and many responded.

There was real animosity directed toward those who pointed out that from a policy standpoint a public option made no sense. It was simply adding another insurance plan to an already-complex and expensive system of hundreds of insurances and that, as had occurred time and again at the state level, it would attract those with the greatest health needs and as a result would ultimately fail because of high costs.

What most people did not understand at that point was that the public option was not only a non-solution to the health care crisis but that it was not even destined to be in the final legislation. Senator Max Baucus reported in March 2009 that it was a "bargaining chip" to get health insurers to accept regulations. Glenn Greenwald exposed this more fully when the Democratic leadership in the Senate actively worked to keep the public option from being included in the Senate health bill. The public option was just part of the con.

5. The Hurrah

The Hurrah phase of a con involves some sort of crisis that must be overcome. This phase started in August 2009, when the Tea Party, backed by Americans for Prosperity (a Koch brothers front group), came out very aggressively against the ACA at local town halls. They called it "government-run" and opposed its fictional "Death Panels." This served to energize the progressive groups to rally around the president and come out strongly in favor of the law. Rallies in favor of health reform were organized across the country.

Health reform advocates were activated further to support the law as the House and Senate struggled to come to consensus. As more aspects of the law that were important to health reform supporters were jettisoned, such as coverage for immigrants and inclusion of reproductive services, and the public option was whittled down to nothing, support for the law became a partisan statement of support for President Obama.

Members of Congress who supported the Medicare-for-all approach told us that they were going to "hold their nose and vote for it." Progressive groups and media feared that if the health bill did not become law, it would ruin the Democrats' chance to hold a majority in Congress in the midterm elections and would destroy the president's chance to be re-elected.

6. The In-And-In

The purpose of the final phase of the con is to make sure the victims do not realize they've been conned.

Obama signed the ACA on March 23, 2010. Immediately the marketing began. The three words we heard the most to describe it were universal, affordable and guaranteed. Of course, the ACA is none of those. But members told us personally that if they told the truth, they wouldn't be re-elected.

Progressive groups started the work of explaining the advantages of the new health law to the public. The few positive aspects of the law were promoted without explaining the big picture. Overall, the ACA is similar to other neoliberal economic policies; it defunds and destroys our public health insurances and further privatizes health care.

The end goal of the ACA con, to make sure people do not realize they have been conned, is ongoing. As we will see below, salespeople, often the same nonprofits who pushed the ACA, are getting big money to sell insurance with Madison Avenue marketing manipulation tactics.

At the same time, leading single-payer advocacy groups fear further marginalization in their communities and so are afraid to tell the truth about Obamacare. The public has been so hoodwinked by the partisan debate between Republicans and Democrats, based on misinformation from both sides, that single-payer advocates are afraid if they tell the truth, their allies, many whom are Democrats, will push them away. So the truth has few emissaries, while the well-funded deceivers continue the ACA con.

The Con Continues: The Product

A fundamental problem with the ACA is that it is based on continuing our complicated private health insurance or market-based system. Despite their advertising slogans, private insurers primarily exist to create profit for their investors or, in the case of "nonprofit insurers," to pay exorbitant salaries to their executives. They care about health as much as Big Oil cares about the environment.

Health insurers make their profits from charging the highest premiums they can and by restricting and denying payment for care. They want to take in as much money as they can, while paying out as little on health care as possible. They have many tools with which to do this, and they've successfully skirted regulations for decades. When they can't make a profit, they simply pull that product from the shelf and create new products.

The public has been led to believe that the ACA has changed the behavior of health insurers. In this section we briefly explain some major areas of concern and why many of the promises of the ACA are false.

More-expensive insurance premiums: A major promise was that people could keep their insurance if they liked it, but many are finding that this isn't working out. Kaiser Health News reported last week: "Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies." The Society of Actuaries released a report in March 2013 that showed insurance pools are set to see an average increase of 32 percent in underlying claims costs by 2017.

The Charlotte Observer reported: "Across North Carolina, thousands of people have been shocked in recent weeks to find out their health insurance plans will be canceled at the end of the year - and premiums for comparable coverage could increase sharply."

The increase in premiums will force more people to use the state health insurance exchanges, where prices are supposed to be more affordable, but even that is not a solution. Russell Mokhiber of Single Payer Action describes the dilemma he faces in West Virginia. Mokhiber received a notice that his current insurance expires January 1, 2014. If he wants to keep his plan, it will cost twice as much. In his state only one insurance company, Highmark, will be listed on the exchange. He called Highmark to find out what his choices were and got bad news: "The skimpiest plan is going to cost me more than I'm paying now and have a higher deductible and out-of-pocket costs."

There are reports of increased premiums from across the country. One reason for the increase in cost is, as USA Today reports: "About a third of insurance companies opted out of participating in the exchanges in states where they were already doing business, according to a recent report by McKinsey & Co. About half of states … will see a 'material decline' in competitors."

Decreased coverage: The ACA will increase the number of people who have inadequate insurance that requires high out-of-pocket costs and does not cover all necessary services. The ACA significantly lowers what is considered to be adequate insurance coverage through its system of tiers. The insurance exchanges offer four levels of coverage, with the least-expensive plans paying for 70 percent and 60 percent of covered services.

These plans include high co-pays and deductibles that are barriers to care - especially when 76 percent of Americans are living paycheck to paycheck. And insurers are restricting coverage further by limiting their networks so they do not include major medical centers or adequate numbers of health professionals.

It is important to highlight that insurers pay only for covered services because people don't usually understand that they will have to pay for uncovered and out-of-network services themselves. The use of out-of-network services is often involuntary and occurs without being known at the time of care, especially in emergency situations.

The New York Times reports:"Most of the 15 exchanges run by states and the District of Columbia do not have provider directories or search tools on their Web sites - at least not yet - so customers cannot easily check which doctors and hospitals are included in a particular plan's network."

People are likely to choose the least-expensive plans without fully understanding that a serious accident or illness could bankrupt them even though they have insurance. And the race to the bottom in coverage will affect everyone. It is already estimated that 44 percent of large employer-based plans will be high-deductible plans by 2014.

Tricks to mistreat those with pre-existing illness: One of the great selling points of the ACA con is that those with pre-existing illnesses will not be denied coverage. This is true, but insurers have many ways to avoid the ill. The ACA was written by an insurance company executive from Wellpoint, Liz Fowler, who went on to be hired by Obama's HHS to implement the law and now works for a pharmaceutical giant. So, all along the way, the insurance companies had someone protecting their interests.

One way to avoid the sick was mentioned above: excluding hospitals where people with serious health problems go, like major medical centers. Another way is by providing poor service to people who have a lot of claims so they change insurers. And a third has to do with the fact that insurance companies are allowed to charge more in geographical areas where health costs are higher. If a plan in a particular area is not making enough profit, the insurance company can simply stop selling in that area.

Insurance companies also can charge three times as much based on age. Because most pre-existing illness comes with age, this greatly undermines the protection of those with pre-existing illness. Insurance companies are excellent at gaming laws and regulations, so we can expect more creative avoidance of people who actually need health care.

Almost no reduction in youths without insurance: One of the highly touted claims of the ACA con was that youths would be covered on their parents' insurance until they are 26 years old. While this is true, the percentage of 19- to 26-year-olds without insurance has merely fallen from 48 to 41. Why? Most parents cannot afford the increased premiums that are required when more family members are covered. As a result this promise has been one of little value, except to the wealthy - and to those selling the Obamacare con.

No cap on out-of-pocket spending: One of the selling points of the ACA con was that it would limit how much people pay out of pocket for health care. Of the thousands of waivers granted by HHS, one was the limit on out-of-pocket spending. The insurance companies claimed that their computers were not set up to handle this change. HHS took this absurd rationale seriously and gave them a waiver on this important provision.

The Con Continues: The Dealers

The most egregious aspect of the ACA is the individual mandate that those without health insurance who do not qualify for public insurance such as Medicaid must purchase private insurance or pay a penalty for being uninsured. The public is being led to believe that the solution to the health care crisis is to increase the number of people who have insurance. This ignores the fact that having insurance does not mean that patients will have access to or will be able to afford the health care they need.

The ACA required states to create new marketplaces for insurance called exchanges or else the federal government would create the exchange. In essence, the federal government is using billions of public dollars to finance the exchanges, hire people to sell insurance and subsidize the purchases. Imagine what a benefit it would be if those billions of dollars were used instead to hire health providers and pay for actual care.

The federal government plays a big role in running 26 of the state health exchanges but is funding all of them. The annual cost of operating the exchanges will be $15 million to several hundred million per state. In the end, consumers will pay the cost through monthly surcharges tacked on to their premiums.

Part of the federal spending will be on "navigators" and "assisters," people whose job it is to help people buy insurance. The Obama administration announced in 2013 that it would be directing $200 million to states, private groups and local health centers so that they can hire workers, called navigators, to sell insurance to Americans.

How are navigators paid? A House Committee on Oversight and Reform issued a report on September 13, 2013, that examined how navigators will be paid. One problem is that many are paid based on the number of people they enroll. Obviously this could lead navigators and assisters to not merely "facilitate" enrollment but to persuade people to enroll. And navigators are not required to disclose this incentive.

This payment structure is just one problem, the House report summarizes, warning of scammers:

"… the training to be Navigators and Assisters will last only five to 20 hours and there is no requirement for a background check of Navigators and Assisters who will have access to highly sensitive personal information, such as Social Security numbers, dates of birth, and income for everyone in an applicant's household. Given the stories about how scammers are gearing up to take advantage of the tremendous confusion caused by ObamaCare, Americans are at an increased risk of being the victim of fraud and identify theft because of the Administration's poor development of its outreach programs."

The official navigators and assisters are only one part of the continued conning of America. The groups that advocated for Obamacare have evolved into Enroll America. The group (whose logo is incredibly similar to insurance giant Wellpoint) not only includes advocacy organizations but also interests that profit from the market-based US health care system, e.g. insurance companies, hospitals and pharmaceutical companies. The president of Enroll America, Anne Filipic, served in the Obama White House, the HHS, the Democratic National Committee and in Obama's 2008 campaign.

Information on the budget of Enroll America has been vague. In June Reuters reported: "In a conference call with reporters, Filipic declined to answer repeated requests for details on the group's budget. In January Congressional Quarterly reported they were eyeing a $100 million budget and quoted founder Ron Pollack, who led an NGO that lobbied for Obamacare, saying: "We keep on saying it's got to be in the significant tens of millions of dollars, and hopefully we reach another digit." Reuters reported that the cost of the public outreach campaign would range into the tens of millions of dollars, with "at least seven figures" going to paid advertising. In a press release they described the advertising campaign:

"Enroll America plans to organize a massive public education/advertising campaign about coverage eligibility and the ways people can enroll in coverage. We expect to involve well-known athletes and celebrities in the campaign. The advertising campaign will be segmented so that it effectively reaches different demographic groups, such as young adults, people in communities of color, low- and moderate-income families, etc. Depending on the availability of resources, we may be able to tailor ads to specific states."

The campaign is expected to spend tens of millions of dollars on polling, focus groups, paid advertising and running its operations with a staff of a few hundred people. Americans will be subjected to all of the tools of Madison Avenue marketing through Enroll America along with sales by navigators, assisters and the insurance industry.

How is Enroll America raising money? Secretary of Health and Human Services Kathleen Sebelius has been one of the fundraisers for the organization. According to the New York Times, her fundraising has caused a political uproar, with some Republicans claiming it was illegal and two House committees investigating the activity. They report: "Senator John Barrasso of Wyoming and Representative Jack Kingston of Georgia, both Republicans, said Ms. Sebelius appeared to be 'shaking down' businesses and other potential donors." The Hill echoed this, reporting that insurance companies felt like they were being pressured by the administration to donate to Enroll America. One concern is that HHS has a lot of power over insurers as the agency can delay or deny approval of their health-insurance plans for federally approved exchanges.

Sebelius is seeking funds from groups like Robert Wood Johnson Foundation and H&R Block. And the Hill noted "Obama himself made a vague but personal appeal for a close partnership with insurers, which some in the industry saw as a precursor to direct fundraising pitches." In April 2013, "Obama reportedly sat in for an hour-long meeting he was initially not scheduled to attend and told insurance executives that the White House and the industry were now "joined at the hip" trying to make the healthcare law work."

Americans want health care, so why do they have to spend so much money to convince people to buy ACA insurance? The American people will be subjected to a sophisticated, echo chamber of marketing to sell them flawed insurance that provides insufficient coverage, huge out-of-pocket costs and limited networks of health professionals and hospitals.

Understand the Con, End It and Replace It

The ACA con is part of a broader con Americans and people around the world are having inflicted on them, the false idea that privatization is a better way to provide services than government. Even though there is virtually no evidence to support this claim and there has been a long history with many examples of privatizationcosting more and providing less, this is a centerpiece of neoliberal economics. Politicians like President Obama and the leadership of the corporate duopoly who believe in market solutions are pushing privatization at home and through big-business-rigged trade agreements like the Trans-Pacific Partnership.

The fundamental flaw of the ACA is that it entrenches a market-based system that treats health care as a commodity and profit center for Wall Street. The big drivers of the rising cost of health care - insurance, pharmaceuticals and for-profit hospitals - continue. The wealth divide that is a major byproduct of neoliberal economics is institutionalized by law under the ACA. Some, like Senator Ted Cruz, will receive the best health care from their employer, in Cruz's case his wife's employer, Goldman Sachs. Others, forced into the individual insurance marketplace, will be divided in four classes based on wealth, and millions will be in Medicaid, the inadequate health plan for the poor. Thus, after a high-stakes partisan battle, we've made no progress in confronting the fundamental problems in US health care. Indeed we have made some of them worse.

There was an easier route and a more politically popular route. All that President Obama had to do was to push for what he used to believe in, Medicare for all. By just dropping two words, "over 65," the United States would not have needed the 2,200-page ACA. Then the country could have worked to gradually improve Medicare so that the United States moved toward the best health care in the world, rather than being mired at the bottom.

To replace Obamacare with the single-payer system, we need to be clear about the shortcomings of the law, especially its fundamental flaw of making a human right, one of many human rights Americans do not realize they have, into a commodity like a cellphone. We need to recognize that ending the corporate domination of health care is part of breaking the domination of big business over the US government and the economy. Health care is at the center of the conflict of our times, the battle between the people and corporate interests, the battle to put people and planet before profits.


your political umm unumm side is showing again   How can it be a flaw SSC when it is working? again 8million+ Whoo the long posts!   


How can it not be flawed when they have no clue of factual numbers and it won't be completed until 2022, yep my political side is showing just like your's has been on your personal thread and any post I make, you are getting good with the dislike vote thing, go for it Gyp, still doesn't stop me from believing this whole medical fiasco will blow up in time, leaving thousands behind with nothing.


they do have factual numbers, do you have an inside of not factual number..   Remember  Congress has not passed a bill in more than 1800 days/ yep I also see your dislikes and some others also,many who do not post it will not blow up because people believe in it, and this president,not Republican congress.where does this 2022 come in a link for this?


I am not going to play the dislike game, really doesn't matter if I have your approval or not, so click away, seems you have been rather busy at it. Very mature !!


I don't see any dislike votes in this topic. Maybe you mean other topics.


yes I gave some dislikes in other topics, as SSC has also. so maturity has nothing to do with it. it is likes/dislikes. I can handle her dislikes.



Health Care Reform Timeline
A Timeline of Health Care Reforms 2010 - 2022

Here is an easy to understand Health Care Reform Timeline 2010 - 2022. The healthcare reform timeline lays out health insurance reforms and health care milestones contained within the Affordable Care Act ( ObamaCare). Find out how the new health care law affects healthcare in the United States and you each year.
What is Health Care Reform?

Obama's Health Care Reform, commonly called ObamaCare but officially called the Patient Protection and Affordable Care Act (Affordable Health Care for America Act, PPACA, or ACA for short), was signed into law on March 23, 2010. The ACA is meant to "provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes".

ObamaCare's reform of the health care system has been an ongoing effort to reform the national health care system. Although it has taken great strides under President Barack Obama, efforts to reform healthcare have been in motion for decades.
health care reformWhy Does the Health Insurance Industry Need ObamaCare's Reforms?

Why reform the healthcare system? Before we get to the health care reform timeline, here are some reasons ObamaCare health care reform was signed into law.

• PBS reports that 44 million Americans are currently without health insurance. Part of this is due to the extraordinary costs of quality health insurance in the US. HealthCare reform ensures these Americans have access to health care.

• The Medicaid part D prescription drug "donut hole" coverage gap was leaving seniors unable to afford their medication or paying out of pocket. The ACA closes the donut hole.

• Government funding for private Medicare Advantage plans is costing the taxpayer money, it was supposed to save the taxpayer money when going on the private market. Obama's Health Care Reform reigns in the wasteful spending.

• Insurance companies could deny you for pre-existing conditions or drop you when you get sick. In 2014 you can no longer be denied coverage or treatment based on health status.

• Insurance companies could drop you for being sick or stop treating you when you reached annual or life-time limits. Over 60% of bankruptcies were related to medical costs, many of these people had insurance. The issue was that lifetime and annual dollar limits didn't cover expensive treatments. The only reason you can be dropped on new ACA protected health plans for fraud and life-time and annual dollar limits are on their way out.

• Insurance companies had no limits on raising your premiums. The rate review provision protects you against unjustified rate hikes. So far the program has curbed the rising cost of employer based premiums and reduced premiums for many Americans due to the new State-based health insurance marketplaces.

• Millions of people are too poor to afford health insurance, yet make too much to qualify for Medicaid. The ACA expands Medicaid and CHIP to over 15 million men, women and children who fell through the cracks. Many State's chose to opt-out of expanding Medicaid coverage.

• Before the ACA preventative measures and wellness visits were not covered adequately. All new plans require essential health benefits and preventive services be covered with no out-of-pocket costs.

• Small businesses have historically had an increasingly difficult time offering health benefits due to cost. The SHOP marketplaces offer tax breaks of up to 50% of employers share of employee premium costs.

• Some of America's largest firms don't offer health benefits. The 2015 employer mandate ensures that full-time workers at large firms have access to health benefits. Small firms are exempted.

obamacare timeline infographic

ObamaCare timeline infographic by Clarity Way.
The Complete Timeline of Obama's Health Care Reform 2010 - 2022

Many of the protections, reforms and taxes are already enacted. Some of the biggest changes roll out in 2014. Our timeline of health care reform breaks down what has already happened and what will happen each year until ObamaCare is fully implemented.

ObamaCare Health Care Reform Timeline 2010-2012

First, let's start with the facts on what ObamaCare has done to reform the healthcare industry so far:

• ObamaCare allows the FDA to approve more generic drugs in order to drive competition up and prices down.

• ObamaCare increases rebates on drugs through Medicare for Seniors.

• ObamaCare closes the Part D Medicare Coverage Gap or "Donut Hole" that was forcing Seniors to pay out of pocket for drug costs. There is also a 50% discount on brand name drugs. Seniors currently get a rebate to cover the costs and ObamaCare closes the Medicare coverage gap for good in 2020.

• The PCORI, an independent non-profit advisory board, studies different types of treatments in order to ensure quality affordable health care under ObamaCare.

• Chain restaurants must now display calories in order to promote wellness and healthy living (this helps to keep the cost of health care down, since less people will need it).

• Health Insurance companies can't drop your coverage when you are sick.

• Individuals can't be denied coverage for pre-existing conditions.

• Children under the age of 19 can't be classified as having a pre-existing conditions

• Children under the age of 26 can stay on their parents insurance.

• Income exclusion for Indian Tribe health benefits that were provided after March 23rd, 2010

• ObamaCare cuts Medicare funding to hospitals and other health care facilities and then reinvests the money back into Medicare reform.

• “Comparative Effectiveness Research” (CER) studies the effectiveness of drugs by comparing drug to drug and seeing which one works best. They will continue to research and publish studies until 2019.

• ObamaCare establishes a “Patient-Centered Outcomes Research Institute” (PCORI) — a public-private entity that oversees ObamaCare's funding, goals, and outside partnerships.

• ObamaCare creates a high-risk pool for individuals with pre-existing conditions. These individuals can still get treatment, but at higher rates. The high-risk pool disappears come 2017, at which point high-risk individuals will buy the same insurance as everyone else. In general there are no pre-existing conditions on new plans starting 2014.

• Insurance companies can no longer discriminate for disabilities or domestic abuse.

• The law imposes a 10% tax on tanning booths. The concept is to tax and regulate products and services that are likely to cause people to need to use their health coverage in order offset what it costs to treat these individuals.

• Rate Hike Review is implemented. Insurers can no longer increase your premiums for profit (also known as "price gouging"). They must justify rate hikes over 10% to the state and then display them on their website (and .gov website) the same day. As of Sept 2012 this measure saved Americans $1 billion. However not all States are using this rule, causing large Premium increases in their respective States.

• The 80/20 rule is implemented. Insurance companies now have to tell their customers how their money is being spent. If they don't spend at least 80% of the money on health care they have to give customers a rebate for the difference. The 80/20 rule has saved Americans $1.1 billion dollars via rebates.

• Health Insurance companies can no longer turn down a claim without an appeal process. This allows customers to have legal standing to fight the appeal.

• Anti-fraud funding is increased and new ways to stop fraud are created.

• Increases rebates for brand name pharmaceuticals purchased through Medicaid.

• New Annual taxes on pharmaceutical companies.

• ObamaCare payment increases to physicians, mostly in rural areas.

• Some Small Employers are eligible for tax credits to help with health care related costs.

• ObamaCare improves treatment for patents with chronic illnesses.

• The law prohibits non-group plans from canceling coverage.

• A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. This does not include insulin, asthma medication or other vital drugs.

• Employers must list employee benefits on their tax form. This helps to determine whether the company will get tax breaks or credits for insuring employees.

• Hospitals in "Frontier States" (ND, MT, WY, SD, UT ) receive higher Medicare Payments.

• Hospitals in "low cost" areas receive higher Medicare payments for 2 years.

• All new plans must provide preventive care free of charge.

• ObamaCare does away with annual spending caps.

• ObamaCare greatly eliminates lifetime limits and reduces annual limits of health insurance plans.

• New tools to fight fraud have been established, this returned more than $2.5 billion in 2009 alone.

• Cuts $716 Billion from Medicare and Medicare advantage and reinvests it back into Medicare and ObamaCare (this obviously covers a lot of ground. Read more on ObamaCare and Medicare.)

• ObamaCare places a $2500 limit on tax free spending under FSAs (flexible spending accounts).

• ObamaCare establishes state consumer assistance programs to help consumers file complaints, appeals, enroll in health care and other consumer related assistance to better understand trouble spots that need oversight.

• Your FSA cost of an over-the-counter medicine or drug cannot be reimbursed from Flexible Spending Arrangements (FSAs) or health reimbursement arrangements unless a prescription is obtained. The change does not affect insulin, even if purchased without a prescription, or other health care expenses such as medical devices, eye glasses, contact lenses, co-pays and deductibles. A similar rule went into effect on Jan. 1, 2011, for Health Savings Accounts (HSAs), and Archer Medical Savings Accounts (Archer MSAs).

• FSA and HRA participants can continue using debit cards to buy prescribed over-the-counter medicines, if requirements are met.

• The hospital "pay-for-quality" program begins. This is part of an overall effort to promote quality not quantity in the health care industry.

• There is a 3.8% tax increase on capital gains over, unearned income, interest, dividends, annuities, rent, royalties, and inactive businesses. Exemptions include income from tax-exempt bonds, veterans benefits and qualified plan distributions such as those from an IRA or 401k.

• The 3.8% tax does not apply to selling your primary residence in most cases.

• The Affordable Care Act has a 5 year plan that works to simplify administrative tasks associated with health insurance such as reducing paperwork.

• Starting in 2012 there is a new tax on private health insurance plans.

ObamaCare Health Care Reform Timeline 2013

• Health Insurance Exchanges open for low to middle income Americans to make it easier for them to shop for health insurance. Those making over 400% of the poverty level can shop on the exchange but will not receive tax credits or discounts. The insurance purchased on the exchange doesn't go into effect until Jan 1st, 2014.

• A health insurance exchange is set up by state or the federal government if the state decides not to run their own exchange.

• Tax credits, discounts on out-of-pocket costs, tax breaks and other subsides are available on the exchange. The help you get on the exchange is directly related to your gross adjusted income.

• There is a .9% ObamaCare Medicare tax on those making over $200k as an individual or $250k as a business or family. This accounts for somewhere between 1.5% and 4.2% of tax payers (these numbers are from recent IRS and census reports, 2% is often used as a rough and not inaccurate estimate. Most sources agree the number is under 3%. 3% is also the number of businesses making over this amount in taxable income).

• 3.8% Medicare tax on unearned income over $200K for individuals and $250K for families and businesses.

• $500,00 deduction cap on compensation paid to insurance company workers

• ObamaCare lays out new rules about the amount that can be contributed to an FSA. A cap of $2,500 is applied to reform FSA's and prevent individuals from overpaying and then needing to rush to use the money before it disappears.

• Part D Coverage Gap or "Donut Hole" reduction goes into effect

• Eliminates deduction for Part D retiree drug subsidies for employers

• ObamaCare increases (7.5% to 10%) threshold at which medical expenses, as a % of income, can be deductible)

ObamaCare Health Care Reform Timeline 2014

• The Individual Mandate: There is a tax starting at 1% of your income or $95 and raising to 2.5% of your income or $685 by 2016 for individuals. For a family, it's capped at $285 in 2014 and rises to $2,085 by 2016. It cannot exceed these amounts. This helps pay for emergency and future coverage you may need. The tax penalty is paid on your tax returns. This is a "tax" not a "mandate".

• You can no longer be denied for pre-existing conditions.

• The ACA takes measures to prevent all types of discrimination in regards to your right to health care. Factors such as pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, and small employer size and industry can no longer be used by insurance companies to increase health insurance premiums.

• The only factors that can affect premiums of new insurance plans starting in 2014 are your income, age, tobacco use, family size, geography and the type of plan you buy. This applies to all plans sold through your State's health insurance marketplace.

• All new plans sold must include Ten Essential Health Benefits.

• No Annual dollar limits on coverage.

• Congress must shop on the health insurance exchanges.

• Pharmaceutical companies are subject to a new tax.

• ObamaCare Medicaid Expansion expands coverage to 15.9 million low-income individuals (The supreme court ruling has given states the opportunity to opt-out of Medicaid expansion).

• Insurance purchased on the health insurance exchange / marketplace goes into effect.

• Employers will be able to shop on the health insurance exchanges for employee insurance.

• Tax credits, tax breaks and help with up-front costs are available to those struggling to pay for insurance.

• There is a new tax on medical devices.

• Insurance companies are taxed based on their market share.

• ObamaCare raises the bar on medical expenses before you deduct them from your taxes.

• Small Business Employers can shop for employee coverage on the health insurance exchange.

ObamaCare Health Care Reform Timeline 2015

• Employers with over 50 full-time equivalent employees must offer health insurance.

• Doctors' income is based on quality of care not quantity of care. This is a vast simplification of the actual documentation in the bill. It is a protection from the current fee-for-service payment model.

ObamaCare Health Care Reform Timeline 2017

• States can implement their own plans which meet the standards of ObamaCare such as single-payer. (similar to ObamaCare, but instead of buying private insurance everyone pays a tax and everyone has coverage)

• Provides states flexibility to allow businesses with more than 100 employees to purchase coverage in the SHOP Exchange

• No more preexisting conditions for anyone including high-risk customers.

ObamaCare Health Care Reform 2018

• All healthcare plans (including plans held since before preventive care was required) must now offer preventive coverage.

• The "Cadillac" tax for higher quality coverage for individuals and employers purchasing insurance for employees is put in place.

ObamaCare Health Care Reform 2020

• ObamaCare fully eliminates the Medicare Gap (instead of just offering rebates to seniors).

For more information on health care reform check out our extensive coverage of Obama Care Facts.
Health Care Reform Timeline Summary

Obama's Health Care Reform Bill is 1990 pages long. The wording is confusing, but the details of every benefit, tax, protection and reform is listed clearly. This health care reform Timeline gives you a good idea of everything that in contained in the bill and how its provisions unfold over the next decade. We will continue to update our health care reform timeline to keep it accurate and up to date in order to help provide all information on ObamaCare health care reform in one easy to use place.


Most of this article is praising AFC My medicare and humana are working together under the AFC because our Governor expanded medicaid and accepted monies to help millions in our state, and the AFC is working in all the states that did this. other states should learn from this, I have never been in the doughnut hole as you call it and I have had medicare for six years. The Affordable Care Act is the law,it is here to stay, and will continue to improve  for  our People.


whoooohooooo good for you


Thanks all compliments appreciated .. thanks for proving that AFC is a good thing. 


Read the article closely, for the loop holes, then remember this was a Democratic site that has to sing the praises of Obamacare to screw people over, in the long range read the taxes that will follow this wreck, then remember they still don't have the whole plan completed, in other words Gyp they are still writing and rewriting it because it is flawed, You swear 8 million signed up, how many really paid premiums ?? No proof how many millions lost coverage because of Obamacare ?? No one wants to talk about the people who lost perfectly good insurance that they liked. remember the words of the great one, 'If you like your insurance you can keep it and your Dr. too' EPIC LIE of the year !!!


I see no loopholes it is doing exactly what it is suppose to do. It already is helping Millions and soon many more.  well the democrats are the best. it has been shown down through the years what hasb een done good for our country with Democrats in office. no proof ? if they signed up they are covered.where is the proof they aren't? o it wasn't a lie.the trash insurance is what Obama was talking about. if the companies didn't meet regulations,all that has been resolved and worked out. Go forward SSC not backwards. the myths lies from the republicans need to stop.they have all been debunked. are where these people who have lost the insurance they liked.I see none coming forward so that is debunked poop also.


Obamacare ‘Enrollments’ May Also Include Duplicates: Congressional Testimony
May. 7, 2014 8:49pm Becket Adams

The White House’s touted Obamacare sign-up number may be inflated due to the fact that many consumers were required during the rollout of the glitchy website to sign up more than once for the same plan, creating so-called “duplicate enrollments,” according to a representative of the insurance industry.

Testifying before a hearing of the House Energy and Commerce Oversight Committee, Mark Pratt, Senior Vice President, State Affairs America’s Health Insurance Plans, raised questions about the White House’s claim that nearly 8 million Americans have signed up for a health insurance plan under the Affordable Care Act.

“Because of the challenges that surfaced with the launch of the Exchanges in October 2013, some consumers were advised to create a new account and enroll again,” Pratt said Wednesday.

“As a result, insurers have many duplicate enrollments in their system for which they never received any payment. In cases where an insurer has a new enrollment for a consumer who previously enrolled, they are not expecting that original policy to be effectuated – even though that data is still reported,” he added.

Simply put, according to Pratt, glitches in the online exchanges that resulted in Americans signing up more than once for the same plan may have created “duplicate enrollments” that are being counted by the Obama administration toward final sign-up figures.

“For example, if there are three people with one enrollment each and one person with two enrollments, the government will report this as five total enrollments,” Naomi Lopez-Bauman reported for Rare. “If the first three people paid for each of their policies and the fourth person paid for one policy, the insurer will report 100 percent payment. In this way, the government numbers may be further overstating enrollments.”

It’s important to note that “sign-ups” are different from “enrollments” as the latter require payment. Further, and despite the fact that the White House tends to use these two terms interchangeably, the House Energy and Commerce Committee announced last week that only 67 percent of the nearly 8 million sign-ups have paid their first month’s insurance premium, meaning only two-thirds of White House’s Obamacare sign-ups are formally enrolled in a plan.

Here’s Pratt’s prepared testimony:




Over 80 percent of ObamaCare enrollees have paid premiums ...
Fox News-18 hours agoShare
Over 80 percent of ObamaCare enrollees have paid premiums, insurers say ... signed up under the president's new health care law have gone on to ... by how much, and how many of those covered were previously uninsured. ... who'd signed up for health plans actually had paid their first month's premium.
Insurers Say Most Obamacare Customers Paid First Premiums
Bloomberg-May 6, 2014
Insurers Say Most Who Signed Up Under Health Law Have Paid Up
Highly Cited-New York Times-May 6, 2014
The insurers speak: Yes, people are paying their Obamacare ...
Opinion-Los Angeles Times-16 hours ago
Insurers: Sizeable Majority Has Paid Premiums
In-Depth-WebMD-1 hour ago
Despite GOP Claims, Obamacare Enrollees Are Paying Premiums

16 Top 10 reasons not to enroll in Obamacare on Sat May 24, 2014 5:25 pm


Top 10 reasons not to enroll in Obamacare
Exclusive: Dr. Elizabeth Lee Vliet offers prescription to 'put control back in your hands'
Published: 03/16/2014 at 3:36 PM

By Elizabeth Lee Vliet, M.D., of the Association of American Physicians and Surgeons

The March 31 deadline for enrolling in Obamacare looms over the undecided. Millions of Americans have lost their private health insurance policies because they do not comply with the costly, expanded requirements of the new health-care law.

Rep. Mike Rogers, R-Mich., asked a poignant question: “Why punish the 85 percent who have earned health-care coverage under their employer to cover the 15 percent who do not?”

But punishment is exactly what Democrats who voted for Obamacare have done.

So now you, as a consumer and patient, face a difficult choice. Enroll or not?

The new policies now offered have fewer choices of doctors and hospitals and cost more for most people. The situation is extremely confusing, but many reasons to avoid the government-run “exchanges” are very clear-cut.

But then deciding not to enroll means you pay a penalty, or tax, as the Supreme Court called it. So what to do?

Here are my top 10 reasons for not enrolling, plus five suggestions for what you might do instead. You weigh the pros and cons, then decide the cost-benefit balance best for you.

1) The Obamacare health insurance policies cost significantly more – likely more than the penalty (tax). Most people can expect to see their premiums double.

2) The Obamacare health-insurance policies limit your choice of doctors.

3) The Obamacare health-insurance policies limit your choice of hospitals. For example, several major state-of-the-art, internationally known cancer treatment centers are excluded.

4) Your out-of-pocket costs will skyrocket, with the new Obamacare health-insurance policies doubling and tripling the deductibles you must pay before coverage will kick in.

5) Your medical privacy is lost when you enroll, and your medical information becomes controlled by government agencies.

6) Your personal financial and health information may be seriously compromised by the security flaws in the website.

7) You are at risk of identity theft by providing your personal information to the “Obamacare navigators,” a significant number of whom have been found to have criminal backgrounds.

8) Enrolling in the Obamacare health exchange may lead to compromises of your Second Amendment rights, as medical databases collect information on gun ownership.

9) Obamacare enrollees are finding it difficult or impossible to cancel their plan if they find a better option.

10) Obamacare policies are basically “managed care” with limitations on your options – and financial incentives for your doctor to restrict your care.

If you do not enroll in Obamacare, what options do you have to protect your health and pocketbook? Here are some solutions that put control back in your hands and allow you to decide how to spend your own money for the medical care you choose:

1) Purchase a very high-deductible, catastrophic medical insurance policy.

2) Use the savings in premiums every month to put money into your self-funded “medical expense savings account” that you control. Even if this account is not tax deductible, the fact that you control how you spend the money is what is critical to your health.

3) Consider joining a religious group cost-sharing program. Examples of these are Liberty Healthshare, Christian Care Medishare and Samaritan Ministries.

4) Seek out cash-pay medical practices, imaging centers and hospitals that offer discounts for cash – pay for services you choose, not for insurers’ promises, or denials, which are becoming more and more common.

5) Purchase a high-deductible international health insurance policy that for much lower premiums offers you the option of medical services in lower-cost countries such as Chile, Costa Rica, Panama, Mexico, Singapore, Thailand, India and others.

Abraham Lincoln said: “You can’t make a weak man strong by making a strong man weak.” That is exactly what Obamacare does: It weakens those who take responsibility for their health, forcing them into a one-size-fits-all wealth redistribution scheme that restricts care to government-approved choices at a government-dictated price.

At its core, Obamacare is about controlling you and limiting your choices for medical care and how you spend your money. Obamacare is not about “affordable care” or “patient protection.” When the government controls your health care, the bureaucrats and politicians decide what you get.

My prescription for good health: Take control of your medical care back into your own hands, in partnership with physicians of your choice.

Elizabeth Lee Vliet, M.D. is a preventive and climacteric medicine specialist with medical practices in Tucson, Ariz., and Dallas, Texas, which take an integrated approach to evaluation and treatment of women and men with complex medical and hormonal problems. Dr. Vliet is also president of International Health Strategies, Ltd., whose mission is twofold: liberty and privacy in treatment options and preservation of the Oath of Hippocrates focus on the individual patient.

Dr. Vliet is the 2007 recipient of the Voice of Women Award from the Arizona Foundation for Women for her pioneering advocacy for the overlooked hormone connections in women’s health. Dr. Vliet received her M.D. degree and internship in internal medicine at Eastern Virginia Medical School, then completed specialty training at Johns Hopkins Hospital. Dr. Vliet is a former director of the Association of American Physicians and Surgeons.


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