Public Law 111–148 – The Patient Protection and Affordable Care Act

 (otherwise known as “Obamacare”)

A Wolf in Sheep’s Clothing

This document will not even begin to detail the unforeseeable ways that “Obamacare” will impact the freedoms and livelihoods of American citizens.   America has bought in to what will likely be more government insertion into our lives and homes, if we do not act wisely in this next election.

It is our irresponsibility as a nation that we must now correct.  We must show our disapproval by removing from office those who threaten to chip away at our freedoms, and tax us heavily for the advancement of big government.

Do you know why you MUST vote those responsible for Obamacare out of offiice?  Consider the following…

ALARMING FACT #1:  Individuals/Families must carry Health Insurance – OR ELSE!

(See Public Law 111–148 Sec. 5000A. Requirement to Maintain to Minimum Essential Coverage)

Whether you agree with their decision or not, some individuals or families decide not to carry health insurance for a variety of reasons.   Perhaps they are young, and have decided to spend their money on other things.   Perhaps they believe the insurance industry is corrupt, and they choose not to carry coverage.   Perhaps they participate in alternative services such as Samaritan Ministries Healthcare insurance.    Perhaps they choose not to have it….just because.

We are obligated as American citizens to act lawfully and pay taxes. Otherwise, there is freedom of choice.   We choose whether or not to vote.  Should we vote?  Absolutely!  Does everyone vote, no indeed.  As an American, do you have the right to decide which commodities you will purchase, and what services you will procure?   Not any more!!!   As of 2014, you will be required to carry a government-approved health insurance plan.   If you don’t – you will be penalized (i.e. – taxed.)  You will be taxed for your decision not to do something.

Let’s compare it to what we are taxed for today.   You want to own property – expect to pay a property tax.   You want to buy a television – expect to pay a sales tax.   You want to drive your car – expect to pay a gas tax.   But, it’s also your right NOT to do those things.  In that case, there is no tax to pay.   The ruling of the Supreme Court, and the law itself now allows government to “tax” you for NOT purchasing something.  Will this be the beginning of a new precedent?  What behavior can we expect to be taxed on in the future?   If this doesn’t outrage you, then what will?

The American’s right to healthcare isn’t the issue at hand.   We can all generally agree that our healthcare system must be reformed, but not at the expense of the American citizen’s freedom to choose.

ALARMING FACT #2:  Employers must provide health insurance for their employees – OR ELSE!

(See Public Law 111–148 Sec. 1513. Shared Responsibility for Employers)

This doesn’t seem like a bad thing does it?   After all, employers should offer health insurance to their employees, right?   And, since this only affects companies with more than 50 employees, what’s to worry about?  Why shouldn’t “big” companies offer health insurance?   Here are two potential fall-out scenarios that will answer the question “why not?”

1. We can all agree that the economy is in trouble.   Jobs are precious.  Employers are cutting costs and eliminating jobs every day.   Now, let’s introduce a government mandate requiring employers to increase their costs and offer health insurance to their employees.   Who is going to absorb that cost?   The employer?   Likely, the employee is going to feel the “cost” of this insurance in his/her own back pocket.   The salary of that employee will inevitably drop (or get redirected) to cover the amount that the new health insurance plan is going to cost the employer.   Or, if the employer fails to offer coverage, perhaps the employee’s compensation will drop by the amount of the tax (i.e. – the fine) the employer will pay for not offering coverage.   Either way, the employee is the one who will probably pay the price.   So, while the employee’s total compensation may not be altered, the drop in his/her take-home pay may seriously affect that individual’s (or his/her family’s) bottom-line.  This will be an ever-increasing burden for low to middle income wage earners, as the costs for coverage increases.

2. The employer may decide that it’s cheaper, in the short-term, to pay the tax rather than cover the bill for each employee’s health insurance plan.   At least for the next few years, the cost of paying the tax is cheaper than the cost of the insurance policy.   (I can even see employers who currently offer health insurance plans deciding that they might want to dump coverage and pay the tax, and let their employees go get a government-sponsored plan.)  By the time the cost of the tax (i.e. – fine) is as much or more than the cost of that employer covering the health insurance premium, the damage will have been done.   Everyone will have moved from private insurance coverage into the government-operated plans, and private insurance companies will be defunct.   Perhaps this is exactly what the government wants!  Perhaps they want employers to pay the fines so that we can move to a government controlled health care system.  Don’t think that is a reasonable conclusion?   Think about this:

Let’s compare the two entities who will offer coverage.   Private insurance companies will offer coverage to individuals.  Those private insurance companies are in business for profit.  The government will also offer government-sponsored plans.   The government is billions of dollars in debt, and yet they keep adding to that debt.  Does the government seem the least bit concerned about making a profit?   What private insurance company is going to be able to compete with the rates of the government-sponsored insurance plan?    Add to that the fact that the law now requires private health insurance providers to pay an annual fee based on each individual company’s share of the total market.   Ultimately, even if the private insurance companies are able to make money, they’ll be fined as a result.   Do you think our government isn’t moving us toward a government-controlled health care system?   Think again.  They’ve done such a fine job with the health and state of our nation.  NOT!  Why would we even begin to want them in charge of our health care?

ALARMING FACT #3:  You must pay for coverage you might not need.  

(See Public Law 111–148 Sec. 1302. Essential Health Benefits Requirements)

Again, whether you agree with it or not, we have always been afforded the right to decide what kind of insurance coverage we’d like to pay for (or none at all).   The new law requires that the following services must be covered by an individual’s policy:   Ambulatory patient services, Emergency services, Hospitalization, Maternity and newborn care, Mental health and substance use disorder services, including behavioral health treatment, Prescription drugs, Rehabilitative and habilitative services and devices, Laboratory services, Preventive and wellness services and chronic disease management, Pediatric services, including oral and vision care.

What if you’re a single male?   It doesn’t matter, you must still pay for a plan that offers maternity care.  What if you have no children?   It doesn’t matter, you still must have newborn care and pediatric services on your plan.  In short, you are helping to fund services for others by being charged for services that you do not, and perhaps will never need.

ALARMING FACT #4:  The cost of eating out is likely to increase.  

(See Public Law 111–148 Sec. 4205. Nutrition Labeling of Standard Menu Items At Chain Restaurants.)

Many restaurants are already struggling to stay in business due to higher food and commodities costs.   This law requires restaurants with 20 or more locations to list the calorie content of their standard fare on their menus and drive-through menu boards.   The supposed reason is that consumers will make healthier choices if they know the calorie and nutrition convent (or lack thereof) of their favorite restaurant selections.   This is, at best, arguable.  Regardless, the costs restaurants incur by adapting their menus and signage is sure to drive up the costs of their food.   Again, the cost will inevitably be passed down to the consumer.  That means YOU.

ALARMING FACT #5:  Preventive Care Free On All Plans

(See Public Law 111–148 Sec. 2713. Coverage of Preventive Health Services)

It’s about time to get something for free, right?   Under this law, an insurance provider must cover preventive health services at no charge to you.   Sounds wonderful!   The doctor will provide you with this preventive care which includes, but is not limited to immunizations, cancer screenings, mammograms, alcohol misuse counseling, breastfeeding counseling, cholesterol screenings, depression screenings, HIV screenings, obesity screenings and counseling, behavioral counseling to prevent sexually transmitted infections, tobacco use counseling and interventions, blood pressure screenings, and any other evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force  (, or as otherwise provided for under this section of the law.

If you don’t have to pay for it, then from whose pocket will these costs be paid?  Somebody has to pay for it.   Some think, “Who cares….as long as I’m not the one paying for it!”    Oh, but don’t be fooled, you are paying for it.   Premiums for health insurance have been sky-rocketing.   The insured American paying health insurance premiums is absorbing the cost for these services in the form of higher premiums.  Someone has to pay for these “free” services.

One reason for higher premiums is due to the increase in Medicaid enrollment.  On average, Medicaid pays the medical providers $.86 for every dollar of care provided.   So, the providers are shortchanged.   How will they make up that difference?   They charge privately insured patients more.

Do you think that President Obama and the members of Congress weren’t aware that health insurance premiums would be affected?   No, in fact, the Congressional Budget Office was clear in their warnings that individual and small-group health insurance premiums would be 10-13% higher under the new law.   They voted to pass the law anyway, knowing that it would raise your insurance costs.   Free preventive care?   There is no such thing!

Another note, before you run out and schedule your “free” physical, make sure you talk with your insurance carrier to understand what is and is not free.  For example, some of the blood tests your doctor might run are covered, but the cost of drawing the blood is not.


Insurance companies and medical providers, out of sheer necessity to protect their own bottom-line, are quite adept at finding ‘loop-holes’.   A quick screening may turn into a diagnostic procedure, which would then cost you money.   Generally, a doctor might screen and treat any problems they find at the same time.   This would cause you to get a bill for something you thought would otherwise have been “free” as preventive care.

ALARMING FACT #6:  Drug Companies and Medical Device Manufacturers are being heavily taxed

(See Public Law 111–148 Sec. 0998.  Imposition of Annual Fee on Branded Prescription Pharmaceutical Manufacturers and Importers)  (See Public Law 111-148 Sec. 0990 Imposition of Annual Fee on Medical Device Manufacturers and Importers)

The law imposes an annual fee (i.e. tax) on manufacturers and importers of branded drugs based on each individual company’s share of the total market.   There is also a 2.3% excise tax on manufacturers and importers of certain medical devices.    Why should you care?   Well, who do you think will absorb the cost of these taxes?   These companies will simply increase the cost of their products.   But, you have insurance right?   Who cares how much they cost…that’s why you pay your premiums.   Have you noticed that your insurance companies have been denying coverage for name brand drugs when there is a generic version of the drug available?

Are you beginning to notice the bottom line?   All of these taxes and increased costs have done nothing but eat into your bottom line as an American citizen and consumer.

ALARMING FACT #7:  Business owners being obligated to provide specialized treatment for nursing mothers

(See Public Law 111–148 Sec. 4207. Reasonable Break Time for Nursing Mothers)

It is inarguable that the design of breast milk is perfect in its caloric content, amino acid concentrations, and enzyme concentrations to best serve an infant’s needs.  This is why expectant mothers are counseled to strongly consider breastfeeding their babies, if at all possible.   It, therefore, seems appropriate to afford nursing mothers the opportunity to take reasonable breaks during the workday to express milk.   The unfortunate flaw is that there is no definition of “reasonable” under the law.  The employer does not have a baseline for what to expect in terms of time away from the job to make this possible for the employee.   By law, that employer must also now provide an appropriate place (other than a bathroom) for that mom to express the breast milk, which is shielded from view and free from intrusion by other co-workers or the general public.  Where does the cost to provide such a place come from?  If a hiring decision for an employer comes down to two qualified candidates, one male and one female, what might that employer take into consideration?

ALARMING FACT #8:  Tax on Indoor Tanning Services

(See Public Law 111–148 Sec. 5000B. Imposition of Tax on Indoor Tanning Services)

It started way back when with the Tea Act in 1773.  Tax on commodities and services has been around for centuries.  But, now we’re getting just downright ridiculous.  If you decide to get a tan by going to a tanning salon, you will pay an additional 10% tax.  The next thing you know, you’ll be taxed for absorbing the sun’s rays.    Freedom is never free…and, neither is your choice to get a tan in a tanning bed.  There is now a hefty tax that goes along with that choice.

ALARMING FACT #9:  You want a maximum benefit insurance plan? Then, cough up an extra 40% for taxes

(See Public Law 111–148 Sec. 9001. Excise tax on high cost employer-sponsored health coverage.)

In another effort to penalize the successful American for actually achieving the American dream and making money, the government is going to levy a hefty tax on maximum benefit health insurance plans (dubbed “Cadillac” insurance plans).   This whopping 40% excise tax applies to plans valued in excess of $10,200 for individuals and $27,500 for families.   What the law does not account for is that some individuals/families making far less than $250,000 per year also choose to participate in Cadillac health plans.  Ironically, President Obama pledged not to tax these families who make less than $250,000 per year.   Oh well….can’t afford the tax – tough!  Then, you can’t have the plan.  Even more frustrating is that as inflation and the cost of medical care increases, so will the value of even moderate benefit insurance plans.   The inflation index allowed for in this law is valued at less than the current increase in medical care costs.   At some point, more and more Americans will have moderate benefit plans that will end up being taxed.

ALARMING FACT #10:  Robin Hood In Modern Terms….new “Hospital Insurance” income tax 

(See Public Law 111–148 Sec. 9015 Additional Hospital Insurance Tax on High-Income Taxpayers)

This isn’t folk-lore or fairy tales folks.  We are back to the days of Robin Hood, except that it is our government that is “taking from the rich to give to the poor.”   Perhaps 100 years ago, a family who made $250,000 (or individual making $200,000) per year was considered rich, but not by today’s inflation standards.     Yet, what is happening is that these individuals/families will be “penalized” for their success by an additional tax in order to help fund the new entitlement program offering health care plans to those who cannot afford them.   We can expect that as inflation increases, more middle-income families will be hit with this tax, because that $250,000 threshold is not indexed for inflation.   Again, are we setting a precedent with the passing of this law?  Will future lawmakers look at this decision and be tempted to use payroll tax as a way to pay for other programs?

ALARMING FACT #11:  Limitation on “tax-free” money…reduction of benefits through Flex-Spending Accounts

(See Public Law 111–148 Sec 9005.  Limitation on Health Flexible Spending Arrangements Under Cafeteria Plans)

Flexible spending accounts (FSAs) and Health Savings Accounts (HSAs) are a wonderful benefit to wage-earners, because it allows them to use their money, before it is taxed, to cover the cost of certain medical expenditures. The employee budgets these funds at the beginning of the calendar year, and uses that money throughout the year toward covered medical expenses.  The law now limits the amount that can be deposited into FSAs and HSAs to $2,500.   It also reduces the number of medical products that taxpayers can purchase using these accounts.   Furthermore, it increases the penalty to 20% for purchasing disallowed products with the HSAs.   With inflation as high as it is, $2,500 will barely cover the cost of an aspirin….oh wait, is aspirin even covered anymore?  Thanks for nothing!

ALARMING FACT #12:  Fair Health Insurance Premiums….Who cares if you’re healthy or not!

(See Public Law 111–148 Sec 2704. Prohibition of Pre-Existing Condition Exclusions Or Other Discrimination Based On Health Status.)

Health insurance companies are no longer able to underwrite policies based on the person’s health.   So, if you’d like to pay premiums that reflect the good care you’ve taken of your body….tough!   You’ll pay the same rates as anyone else.

ALARMING FACT #13:  Want cosmetic surgery?  Fine….but, you’ll have to pay a tax for that choice.

(See Public Law 111–148 Sec. 5000B.  Imposition of Tax on Elective Cosmetic Medical Procedures.)

Whether you’re a proponent of elective cosmetic surgery or not, the bottom-line is that an individual has had the right to choose whether or not they would like to have a surgeon sculpt a smaller nose, or to medically eliminate wrinkles, etc.   Under the law, you now still have that “right”…but you will be taxed for the decision to exercise that right.   There is now imposed a tax equal to 5% of the amount paid for such elective procedure.

Food for thought:   Do you see the theme throughout this document?  Free isn’t free!   Who is paying for this wonderful new health plan for all Americans?   YOU!   Even more importantly, your freedom isn’t free.   Your freedom to choose is being heavily taxed.

Oh yes, and the lawmakers who think this is such a great idea – they have exempted themselves from participating.   How nice for them!

We must show our government our extreme dissatisfaction and disapproval, and vote these politicians, who are so willing to spend our hard-earned money for us, OUT OF OFFICE!