Out-of-pocket spending: ObamaCare’s silent killer

Dr. Eric Novack Contributor
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As the true intentions of ObamaCare’s supporters becomes clear — nothing short of the complete transfer of health care decision-making power from patients to politicians — it’s the cost-sharing provisions in the president’s new law that should worry us most of all.

ObamaCare explicitly and implicitly prevents Americans from spending their own money for legal health care services. It also gives endless regulatory authority to bureaucrats to interpret the law in ever more restrictive ways.

Taking the language in the law and twisting it to further a statist political agenda is already happening. As the Wall Street Journal pointed out on September 24th:

Guaranteed issue for kids wasn’t included in the ObamaCare legislation. The sloppy legal wording only precludes insurers from selling children’s health plans that exclude coverage of pre-existing conditions, not that they must sell a full plan to anyone who applies regardless of health status.

But Health and Human Services Secretary Kathleen Sebelius unilaterally decided that Congress had meant something else. “To ensure that there is no ambiguity on this point,” she wrote to the insurance industry trade group in March, “I am preparing to issue regulations in the weeks ahead ensuring that the term ‘pre-existing condition exclusion’ applies to both a child’s access to a plan and to his or her benefits once he or she is in the plan.”

In other words, the law’s language was used, to borrow a phrase from Democrats promoting the law, as a “starter house” which could be arbitrarily modified to place even more power in the hands of politicians.

And the language concerning cost-sharing, buried in Section 2713 of the Democrats’ 2,400-page monstrosity, indeed goes to great lengths to expand the power of politicians. Among the services citizens are banned from using their money to purchase? Immunizations; necessary preventive care and screenings for infants and children; and certain need screenings and preventive screenings for women. The list in 2713 is exhaustive — and the language is plain: there will be not a single dollar of discretionary, out-of-pocket spending by patients, even if the patient insists on a legal course of treatment.

In other words, if the government does not “approve” of a test or service, Americans will be unable to get access to it.

Of course, the regulations likely will not be written that way. Instead, they will be couched as a “consumer protection” from unscrupulous providers.  Though with significantly enhanced rules and laws to stem “fraud and abuse” within the system, providers will be terrified to offer anything that the government has not approved.

It is critical to understand that, under Medicare rules, even an inadvertent mistake where the wrong code — chosen from the list of over 22,000 — is used to file a claim, the consequences can be fines AND JAIL for a physician.  The intensity and severity of those punishments goes up under ObamaCare.

The ultimate consequence is that, when it comes to preventative care, ObamaCare has succeeded in ensuring that only politicians and their cronies will be making the health care decisions for American families.

The new health care law goes even further in its effort to severely limit the ability of Americans to spend their own money.  The “stealth” nature of the provisions implies intent; these are not “unintended consequences.”  To understand this, you have to examine the following three excerpts.  The first two are from the new health care law.  The third is from the IRS Code of 1986.

On page 43 of the health care law, Section 2707 (b): “COST-SHARING UNDER GROUP HEALTH PLANS. — A group health plan shall ensure that any annual cost-sharing imposed under the plan does not exceed the limitations provided for under paragraphs (1) and (2) of section 1302(c).”

Section 1302(c) can be found on page 47: “The cost-sharing incurred under a health plan with respect to self-only coverage or coverage other than self-only coverage for a plan year beginning in 2014 shall not exceed the dollar amounts in effect under section 223(c)(2)(A)(ii) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively, for taxable years beginning in 2014.”

Seeking out Section 223(c)(2)(A)(ii) of the IRS Code of 1986 ends with this discovery: (I) $5,000 for self-only coverage, and (II) twice the dollar amount in subclause (I) for family coverage.”

To borrow a line from the president, let me be clear, the new health care law puts an absolute limit on the right of Americans to spend their own money for health care services and treatments that fall under the control of their insurance plan.  To spend beyond that is illegal as of 2014.

Critics will claim that this is a “chicken little” strategy to frighten Americans into opposing the law and seeking its repeal.

Those critics are clearly unfamiliar with, or like to deny understanding of, Section 4507 of the 1997 Balanced Budget Act.  This provision lays out the rule that Medicare patients may not spend their own money to get care for a treatment covered by Medicare from a doctor who accepts payments from Medicare.  If the doctor wants to make a contract with the patient to accept either more OR LESS than the Medicare-allowed amount, the doctor must give the government 90 days notice and drop out of the Medicare program ENTIRELY for 2 years.

This stunning restriction on the rights of seniors and their doctors survived the first court challenge against it in 1999 in the case United Seniors Assn. v. Shalala.

The intent of Nancy Pelosi, President Obama, Harry Reid and their allies on health care reform is clear: place every health care decision and every health care condition in the hands of politicians and the self-professed “experts.”  No provisions are more insidious than those impacting the fundamental rights of Americans to seek care with their own resources.  And it is why the proposed constitutional amendments in Arizona, Colorado, and Oklahoma this November will place this freedom clearly and plainly alongside freedom of speech, freedom of religion, and freedom of the press.

Eric Novack, MD, is the chairman of the U.S. Health Freedom Coalition and chairman of Arizonans for Health Care Freedom.