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Help replace the Affordable Care Act of 2010.

Investigative Report:
March 2010 Law: Benefits and Burdens

Affordable Care Act of 2010
(PPACA/HCERA)(also called “Obamacare”)

Benefits. The law is providing and will provide
             health care access and additional health care benefits to many Americans.

Burdens. The law will cause … has already started causing high costs and high taxes.
             And it is going to cause specific additional cost burdens.
             The law will imposes government intrusions on the lives of millions of Americans.

Position at Contents of this report about the March 2010 Law.

CONTENTS OF THIS REPORT regarding March 2010 Law
             (Affordable Care Act of 2010 or “Obamacare”)


Following are links to the sections of the report:

Summary: Conclusions About the
                      Affordable Care Act of 2010

                 Benefits and Burdens

       Reasons that high costs and high taxes will result
           (or would have resulted)

SPECIAL NOTE: Some of the items in the list of reasons for high costs are the benefits that some Americans are either enjoying or are looking forward to having by the year 2014 … at a potentially very heavy cost to the majority of Americans.

       Additional Cost Burdens
       Government Intrusions

What “affordable care” means via the Affordable Care Act of 2010

The Complexity of the March 2010 Law

Flowchart of the complexity of the way we currently pay for health care
       (being made worse by the March 2010 law)
Flowchart of the simplicity of Improved Medicare for All
       and a side-by-side comparisons

Alternative Solution

Related Information and Sources


Links to:
— March 2010 Law Detailed Section-by-Section Analysis
— the Financial Impact of PPACA/HCERA as determined by CMS.

Background with Note About “Minimum Representation” (of the impact of the law)

Additional Information
    including an important historical perspective of the law

End of Report: the Bottomline About the March 2010 Law

Summary: Conclusions About the
Affordable Care Act of 2010

Benefits and Burdens

  • Millions of Americans will get access to health care.
  • Millions of Americans will receive additional heaalth care benefits.
  • Health care will be more costly than ever before.
    • Health care costs will sky-rocket due to the requirement that over 1300 health insurance companies will be required to provide additional benefits.
  • Our taxes will increase significantly due to over 600 government-related actions, initiatives and responsibilities related to the law.
  • Government intrusions will be imposed onto the lives of millions of Americans.
  • Tens of millions of Americans will still have no health care access, because the law establishes a new version of a health-care-NOT-for-all system [Different groups have come up with different estimates ranging from 20 to 40 million.]



that high health care costs and high taxes will result

for American individuals and families

from the continued implementation of the Affordable Care Act of 2010

Reasons there will be

Higher Health Care Costs
due to higher premiums and
higher out-of-pocket costs

Reasons there will be

Higher Taxes

As a result of our section-by-section analysis of the March 2010 law (linked at “Related Information”) we have confirmed the following:

The March 2010 law has many sections that will cause sky-rocketing increases in health care costs, such as the examples of health insurance premiums, deductibles, co-pays and coninsurance. Why? Because, as already dramatically demonstrated in the state of New York (1), health insurance companies that are required to spend more money on health care will raise the costs to their policy-holders in order to be able to stay in business and make profits.

See the examples below.

As a result of our section-by-section analysis of the March 2010 law (linked at “Related Information”) we have confirmed the following:

The March 2010 law includes hundreds of sections that will expand government organizations and activities. Therefore, our taxes will increase.

See the examples below.

Parts 1 through 5 of the law

Parts 1 through 5 contain about 300 sections of the law.

         Examples from our analysis:

Regulations that are of significant size and number will cost health insurance companies money. Those costs will then drive up the cost of their policy premiums and other charges, such as co-pays and deductibles.

Some of the list below is also a list of benefits that many Americans either have experienced or may look forward to having by the year 2014 … at a potentially very heavy cost to the majority of Americans.

(See Related Information and Sources for the link to the detailed analyisis.)
Sec. 2711. No lifetime or annual limits.
Sec. 2712. Prohibition on rescissions.
Sec. 2713. Coverage of preventive health services.
Sec. 2714. Extension of dependent coverage
— until age 26, on parent’s health insurance.
Sec. 2715. Development of uniform explanation of coverage documents and standardized definitions.
Sec. 2715A. Provision of additional information.
Sec. 2716. Prohibition of discrimination in favor of highly compensated individuals.
Sec. 2717. Ensuring quality of care; requires ins. cos. to report information to HHS.
Sec. 1101. Immediate access to insurance for people with a preexisting condition.
Sec. 1102. Reinsurance for early retirees.
Sec. 2701. Fair health insurance premiums.
Sec. 2702. Guaranteed availability of coverage.
Sec. 2703. Guaranteed renewability of coverage.
Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination based on health status.
Sec. 2705. Prohibiting discrimination against individual participants and beneficiaries based on health status.
Sec. 2706. Non-discrimination in health care.
Sec. 2707. Comprehensive health insurance coverage.
Sec. 2708. Prohibition on excessive waiting periods.
(This is waiting time to get covered by a health insurance plan.)
Sec. 2709. Coverage for individuals participating in approved clinical trials.
Sec. 1251. Preservation of right to maintain existing coverage.
Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers and group health plans.
Sec. 1253. Annual report on self-insured plans.
Sec. 1301. Qualified health plan defined.
Sec. 1302. Essential health benefits requirements.
Sec. 1303. Special rules (abortions).
Sec. 1342. Establishment of risk corridors for plans in individual and small group markets.
(This section specifies that payments will be made from the federal government directly to health insurance companies and vice versa.)
Sec. 1343. Risk adjustment.
(This section specifies that payments will be made from the states directly to health insurance companies and vice versa.)
Sec. 1401. Refundable tax credit providing premium assistance for coverage under a qualified health plan.
Subsection of Sec. 1401:
Sec. 36B. Refundable credit for coverage under a qualified health plan.
Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health plans.
Sec. 1411. Procedures for determining eligibility for Exchange participation, premium tax credits and reduced cost-sharing, and individual responsibility exemptions.

   Examples from our analysis:

There are over 600 reasons that government spending will increase, which will increase our taxes.

We provide a list below of government-related activities and government-sponsored activities that include new responsibilities, new programs, new commissions and advisory groups and more, as documented below and in our analysis.

240 sections of the law must be enforced by the government, which means more government employees to do the enforcing.

205 sections for which the HHS must fulfill responsibilities, which means an expansion of HHS, Health and Human Services

… plus additional responsibilities defined for various other agencies and departments of the federal government:
Government Accounting Office (GAO), the Office of Personnel Management, the Secretary of Labor, Internal Revenue Service (IRS), the President, AHRQ, CMS, TRICARE, MedPAC, NAIC, OIG, FDA, CDC, ATBCB, and SG. See the **[Guide and Glossary](#Guide and Glossary)** for a list of acronyms.

Among the sections of the law:

    2 sections create advisory boards

    3 sections create commissions.

   18 sections establish demonstration projects and programs.

   30 sections establish grant-supported programs.
    This will generate thousands of individuals and groups
    initiating, writing, and submitting grant proposals.

   98 sections specify state-related responsibilities,
   most of which apply to all 50 states

In addition, sections of the law specify
— extending and expanding existing programs
— creating loan repayment programs for students
— creating pilot programs and projects
— offices specific to women’s health
— responsibilities of tribes and territories
— studies, task forces, working groups

Parts 6 through 10 of the law

Parts 1 through 5 contain about 90 sections of the law.

Additional requirement on health insurance companies to follow the regulations specified in this law.

Examples of the additional requirements:

— an excise tax of 40 percent for any health coverage plan that is employer-sponsored and considered to be high cost, such plans that cost over $27,500 for family coverage. These are often called "Cadillac plans" when a reference is made to the March 2010 law. These plans would be the excellent health insurance benefits that some large companies would have offered in the past, but might very well not offer in the future due to this EXTREMELY high tax on those kinds of health insurance plans.

— an annual fee paid to the government

— a limitation on the deductibility of executive compensation

Additional government activities that will raise our taxes due to an increase in spending.

Over 60 additional government groups, roles and activities:
grant programs, pilot programs, boards, councils, advisory panels, centers, offices, directors, funds and demonstration projects.


More Information about the Affordable Care Act of 2010, the March 2010 Law

Additional Cost Burdens

Examples of additional cost burdens identified in our section-by-section analysis, linked below in Related Information:

—  9 sections of the law place responsibilities on employers
—  2 sections of the law place responsibilities on communities
—  7 sections of the law place responsibilities on hospitals

More Information
Suggestion: If you go to one of the following web pages, return to this main web page when you are done.

Government Intrusions


Section 1413
Automatic (mandated/forced) enrollment of citizens into Medicaid and CHIP.

Section 1414
Govt. disclosure of citizen tax info to whatever governmental departments, persons or databases that need to determine eligibility for this health-care-NOT-for-all system.

Section 1501
Citizens mandated/forced to pay for health insurance, unless eligible for a government program, such as Medicaid or CHIP.

Section 1501 Subsection 5000A.
Citizens required to have health insurance in 2014.
The government penalizes citizens who don’t.

Section 1511.
Automatic (mandated/forced) enrollment of new employees when there are more than 200 employees

Section 2001.
Automatic (mandated/forced) enrollment of the lowest-income citizens into Medicaid

Section 2004
Automatic (mandated/forced) enrollment of former foster care children into Medicaid.


More Information about the Affordable Care Act of 2010


What “Affordable Care” Means
Via the Affordable Care Act of 2010, the March 2010 Law


As per the March 2010 Law (Affordable Care Act of 2010) the federal government makes health care policies “affordable” NOT by cutting the cost of health care, but by paying for part of the premiums and other costs of millions of Americans, as the cost of those premiums increases dramatically.

The federal government’s payments are our taxes going directly to the health insurance companies to limit the maximum amount that some Americans must pay for health insurance.


  • Health care costs will continue to be out-of-control because we will keep and expand all three kinds of bureaucracy.
  • The U.S. Congress defines what their members think is a reasonable amount that Americans should pay health insurance companies, based on their percentage of income reported to IRS compared to federal poverty level and size of family.
  • When a health insurance company representative notifies the secretary that it is receiving a reduced payment for a health insurance plan, the secretary will “make periodic and timely payments to the issuer equal to the value of the reductions.”

Details about how “affordable care” is to work

  • The law’s Section 1402 Parts (c)(1) and (c)(2) define “reduction in cost-sharing”. The law defines the percentages (compared to our income) we should pay for health care to health insurance companies.
  • If a person has insurance and pays “too much” of their (IRS) household income, then the federal government (via the March 2010 Law) will pay the additional amount (the difference up to the actual costs of having their specific health care policy) directly to the health insurance company.
  • The Congress decision about how to pay the difference is in Section 1402 (c)(3) of the new law: Public Law 111-148 of the 111th Congress. The law reads: “… An issuer of a qualified health plan (a health insurance company) making reductions (of premiums to an American) under this subsection shall notify the secretary of such reductions and the secretary (the federal government via the HHS Secretary’s authority) shall make periodic and timely payments to the issuer equal to the value of the reductions.”

Comment: the result is that the United States is keeping and expanding its bureaucracy and inefficiency for how health care costs are paid.

Note: the above procedure of direct payments from the government is only one example of multiple sections of the law where direct payments are made to health insurance companies from either the federal and/or state governments.


The Complexity of the March 2010 Law


Flowchart of the Current Way of Paying for Health Care

Due to the March 2010 law, the complexity of how the U.S. pays for health care will increase instead of decrease. That is bad for Americans and America. Position at chart.


Flow Chart:
Complexity of the Way We Pay for Health Care
… made more complex with the Affordable Care Act of 2010

U.S. Congress Support for Single-Payer



to Improved Medicare for All

Comparison to Improved Medicare for All

Flow chart. See the following flow chart of how we will pay for health care with Improved Medicare for All. The Affordable Care Act of 2010 maintains and expands government programs, increasing our taxes. It also maintains and expands the use of health insurance companies. Improved Medicare for All (flow chart below) reduces bureaucracy: cutting of government programs, slashing the degree of participation of health insurance companies, and eliminating most or all of the supporting, related bureaucracy.

Side-by-side comparison. At the following separate web page you can see the details:
see the side-by-side comparison between Improved Medicare for All and the health care reform law of March 2010.


We need to replace complexity with simplicity.


Flow Chart: Improved Medicare for All


Alternative Solution
Improved Medicare for All

We need to replace the Affordable Care Act of 2010 to:
             1) cut the country’s health care costs and provide dramatic cost efficiency
             2) provide more benefits than the Affordable Care Act of 2010
             3) decrease the cost burdens, tax burdens and resulting hardships
             4) increase freedoms, providing peace of mind.

Side-by-side comparisons to the alternative

  • Health Care Reform: Comparison (pdf) and How to Get the Best. Fact sheet with fewer words.
  • Health Care Reform: The Best of Two Choices (pdf) and How to Get the Best. Fact sheet with more details.
  • If you have any difficulty accessing a pdf file, please go here.

Related Information and Sources

Related Information about the Affordable Care Act of 2010


  • 68 page (pdf) document “Affordable Care Act: Section-by-Section Analysis with Changes Made by Title X and Reconciliation” by the Democratic Policy Committee.
  • 907 page document (pdf): “Ppaca&Hcera; Public Laws 111-148&111-152: Consolidated Print”.
  • Flow charts were designed and constructed by members of the Medicare for All Teams that support this website.
  • If you have any difficulty accessing a pdf file, please go here.


Background with a Note about “Minimum Representation”

We started in October 2010 with a long, but successful, search for the best source document, which combines and summarizes the new law (Public Laws 111-148 and 111-152). A two-person team then invested many hours doing a detailed analysis of it. This report is the result.

Note about “Minimum Representation”. Consider that many of these numbers on this web page are minimum numbers and a minimum number of examples. That means that this report of information is a minimum representation of the impact of the Affordable Care Act of 2010.

Why is this considered a “minimum representation”? There are two reasons:
— 1 — The law itself is very large. We may have missed a few of the cost burdens and perhaps several of the personal intrusions that March 2010 law places on our society.
— 2 — Most importantly, the law is not the same as the resulting regulations, because many of the sections of the law become (multiple) detailed regulations issued by various government departments, especially Health and Human Services.

In other words, the Affordable Care Act of 2010 is a huge law with hundreds of sections and potential impact and much complexity.
This report gives us all “some idea” that it must be replaced.
Or … if it has already been replaced when you read this, then you have “some idea” of why it needed to be replaced.

Additional Information

About the March 2010 Law. The law includes: the Patient Protection and Affordable Care Act (PPACA) H.R. 3590 and parts of the Health Care and Education Reconciliation Act (HCERA) H.R. 4872 … developed by the U.S. Congress and signed into law by President Barack Obama in March 2010.
Public Law 111-148 of the 111th Congress and
Public Law 111-152 of the 111th Congress

Obamacare?. See: Obamacare: What is it?. What it is. What it’s projected impact is. What it is NOT. And more.

The three types of bureaucracy.

Out-of-control health care costs. Americans need to know that the United States is the only free-market country with out-of-control health care costs … and how clearly this is seen in a graphical comparison with Canada.

About “the secretary”. The word “secretary” occurs 3,267 times in the Affordable Care Act. The majority of those times the word “secretary” means the “Secretary of Health and Human Services”, since the words “the secretary” occur 2,544 times.

Officially Expected Increase in Health Care Costs. The Center for Medicare and Medicaid Services (CMS) Chief Auditor reported the expected negative financial impact of the law via much higher costs: at least $300 billion over the first 10 years. This was reported within a month after the law was signed.

Options for Learning More About (… and perhaps getting confused about? …) the March 2010 Law.
The number of people and organizations developing documents about the March 2010 law is incredible. One can do a Google search for “affordable health act” and pdf and get way more than one million search results. Observation: The amount of activity already initiated by this complex law is obviously already costing the United States in our time, energy and billions of dollars. Many people want to get some of the hundreds of billions of dollars of government expansion and spending.

  • Flow Chart pdf versions are available:
    Current way of paying for health care: flow chart (pdf)
    How we will pay for health care with Medicare: flow chart (pdf)


Accessing PDF Files

If selecting a link for a pdf file does not cause a download of the document to your computer, then you may need to install Adobe Acrobat Reader on your computer. You can download a free copy by clicking on the following image:

Get Adobe Reader


End of Report:
The Bottomline About the Affordable Care Act of 2010

Many Americans have benefited and will benefit.

The cost of the benefits will not be affordable.

Higher health insurance costs (and/or out-of-pocket costs) will result from the law placing many requirements on health insurance companies, which then will pass the increased costs onto us, the insured Americans.

The latter action has already been demonstrated by the real life demonstration in the state of New York when regulations were placed onto health insurance companies, who then passed on the additional costs to the insured. You can see from the New York state website that a family can pay for health insurance for $40,000 to $50,000 per year premiums plus all of the out-of-pocket costs.
See more at regulations.

Higher taxes will result from the law dramatically expanding government rather than shrinking it. To put this another way and SHOUT IT:

A U.S. law which has over 600 government actions and roles to perform cannot be good for Americans or America.

A new U.S. version of a health-care-NOT-for-all system will be implemented at a relatively high cost.

The best alternative would be a health-care-for-all system as per Improved Medicare for All via single-payer health care.

Government intrusions to be implemented by the Affordable Care Act will be most likely be deemed by Americans to be unacceptable intrusions on their lives.

Important Historical Perspective of the Law.

“The Affordable Care Act of 2010” represents the 8th time during the past 7 decades that the U.S. Congress has failed to legislate a health-care-for-all system in the United States.

The world view of health-care-for-all implementations
           includes the times of those failures of Congress to act.


The Alternative Solution is Needed.

Sign Up to Help Replace the March 2010 Law Complexity
with the Simplicity of a Health Care for All System

Our Suggestion: Improved Medicare for All


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