March 2010 Law: Section-by-Section Analysis
of the Affordable Care Act of 2010

PPACA/HCERA (“Affordable Care Act” or “Obamacare”)

Costs. In the tables below, we documented in column "Higher Insurance Premiums and/or Higher Out-of-Pocket Cost" the actions that are either definitely going to increase those costs or likely going to increase those costs.

Taxes. Similarly, we have documented in column "Increases in Taxes" the actions that are either definitely going to increase taxes or likely going to increase taxes.

 

Introduction to the Analysis

Scope. This report is based primarily on the almost 300 provisions in Parts 1 through 5  out of the roughly 390 provisions of so-called Affordable Care Act.. There is also some analysis of Parts 6 through 10.

            What this report is: an evaluation of the impact of the law on costs and taxes.

            What this report is not: an explanation of the timeline of the law’s implementation,
                                   which started in 2010,
                                   implements major changes in 2014 and
                                   is scheduled to be completed by 2018/2019.

Column 1: Section
The section’s title
… plus an excerpt of the section’s summary description, if we included an excerpt
… plus Our added comment in italics and parentheses, if we added a comment.

   [X]: About sections marked with an [X] in the first column:
          These are for sections that are clearly NOT required for
          either the implementation of or operation of Medicare for All
          (More of the sections might find into this category. The sections marked [X] make up a bare minimum group of over 130 examples, which include sections that are clearly going to increase costs and/or increase taxes.)

Column 2: Impact of Higher Costs
Insurance premiums and out-of-pocket costs will increase due to insurance companies following over 50 sections of the law, since they must have increased revenues in order to balance their increased costs of operation.

Column 3: Impact of Higher Taxes
… due to the enforcement responsibilities of the government (federal or federal plus 50 states) to enforce (meaning enforce, manage or monitor/report) almost all of the sections of the law.
… due to the expansion of the Internal Revenue Service (IRS) to handle the sections of the law that require action by the IRS.
… due to the responsibilities of the government and the states to perform roles and responsibilities as defined in most sections of the law.
… due to the government having over 150 programs, funds (and funding programs), commissions, advisory boards, councils, offices, centers and other government or government-supported entities that are either added or renewed/continued by the new law.

Intrusions: sections marked with an [A] in the third colum
        These are actions that may be considered by some people as government intrusions on citizens’ lives.
        To review these do a search for [A] via your web browser. For example, Ctrl-F to find [A].

Special notes: sections marked with an [N] in any of this report
        These are special notes of explanation.
        To review these do a search for [N] via your web browser. For example, Ctrl-F to find [A].
        An example of this is the identification of "Cadillac" health insurance plans,
        a term that is heavily used about the law, but is not mentioned in the law.

Summary Regarding the Tables Below. The tables of information below document the reasons: what sections of the Affordable Care Act of 2010 will cause burdens of higher costs and higher taxes on Americans due to an incredible increase of complexity to an already complex way for a nation to pay for health care. Note: this combination of higher costs and higher taxes will significantly increase the interest in most companies to transfer their business needs and operations to countries other than the United States.

If this is your first time here, please review the Guide and Glossary
Examples from Guide and Glossary
  Govt. = federal government or federal and state governments
  HHS = Health and Human Services, often referenced as "Secretary" for the HHS Secretary
  Ins. cos. = health insurance companies
  resp. = responsibility defined in the section
  States = state governments
  For remaining information go to the Guide and Glossary

Section-by-Section Analysis
 
of the March 2010 Law ("Obamacare")

Sections of the law and their impact:
Part 1    Part 2    Part 3    Part 4    Part 5    Parts 6-10

Guide and Glossary

Guide to Reading the 2nd and 3rd Columns of the Tables
 
(1) Govt. must enforce, manage or monitor/report the elements of this provision.

— Govt: enforce regulation — means that the federal government will need to do whatever is required with respect to paying for resources, especially hiring and maintaining necessary personnel, that will enforce the regulation(s) of a provision.
— Govt. via HHS must fulfill resp. — means that the Health and Human Services department, as led by the HHS Secretary, has specific responsibilities defined in the specific provision and must fulfill those responsibilities. This responsibility often requires long-term responsibilities for which long-term staffing is required. In some cases the responsibility  may be a short-term project that must be completed, still requiring some degree of resources.
— Govt. via GAO must fulfill resp. — means that the Government Accounting Office has specific responsibilities defined in the specific provision and must fulfill those responsibilities.
— Govt. via Labor Sec. must fulfill resp. — means that the Secretary of Labor department has specific responsibilities defined in the specific provision and must fulfill those responsibilities.
— Ins. cos. must follow regulation — means that each health insurance company must follow the regulation(s) of that provision. In many or most cases that means a significant financial obligation to comply with the regulation. That significant financial obligation will then need to be offset with income from the company’s customers who buy the health insurance plans.

Govt. disclosure of citizen tax info. — This is disclosure of IRS tax information to whoever needs to determine eligibility, such as for the automatic (forced) assignment of a person into Medicaid or CHIP, where the IRS provides information to HHS personnel, who then notify the states of the persons who are eligible so that the system can ensure that they are enrolled..

Providers — health care providers

Glossary

AHRQ: Agency for Healthcare Research and Quality
Allied health:
CDC: Center for Disease Control
CHCO: Coordinated Health Care Office
CHIP: Children’s Health Insurance Program
cont.: continued
demo.: demonstration
educ.: education
HCBS: home and community based services
GAO: Government Accountability Office
Govt. = federal government or federal and state governments
HHS = Health and Human Services, often referenced as "Secretary" for the HHS Secretary
ins.: insurance
Ins. cos. = health insurance companies
LIS: low-income subsidy
MA-PD plans: Medicare Advantage Prescription Drug plans (a privatized part of Medicare)
Medicare Advantage Cost Contracts
MedPAC: Medicare Payment Advisory Commission
mgmt.: management
NAIC: National Association of Insurance Commissioners: website
OIG: Office of the Inspector General
pgm.: program
PPS: prospective payment system
prev.: preventive or prevention
rec.: recommendations
resp. = responsibility defined in the provision
rqmts.: requirements
SG: Surgeon General
States = state governments
temp. = temporary