PPACA: Are you shocked?

The list of PPACA broken promises is growing daily. Rep. Nancy Pelosi was right; they did have to pass the bill so we could see what was in it. Families with incomes under $250,000 certainly don't like what they see. Anyone who thought we could add all of these goodies for free probably still believes in the tooth fairy. Some of the taxes are not frontline increases, but are more insidious and corrosive. Medical device makers now have to add a 2.4 percent surcharge on any device costing more than $100. Who do you think is going to have to pay that additional cost?

New CBO estimates hike the estimated program costs from their original prognostication of $814 billion to $1.047 trillion over the next 10 years. Interestingly, the administration that made the aforementioned promise to the country now contends that money raised from taxes, penalties and fees will offset those costs. Seriously? Re-read my recent column on the goings-on in Massachusetts and see how that philosophy is working out for the Bay State.

We were told that costs would go down, but the IRS now estimates that the least expensive bronze plan will cost a family of four nearly $20,000 a year in 2016. That is an increase of $4,000 from the average cost a family paid last year. No one today believes that health care will be improved.

A shortage of primary care doctors combined with a glut of newly insured (maybe we should say covered — it is getting increasingly difficult to call something insurance that is not insurance) citizens is a formula for public clinics. While that scheme works in some countries, America is not some countries. Americans don't have a propensity for waiting in lines unless they come away with a new electronic device with a name beginning with a vowel.

Now even the unions that were foursquare in favor of PPACA are getting cold feet. They are worried the law will drive up the cost of providing health care plans and make them less competitive. They are lobbying to make some of their members eligible for federal subsidies. Remember, those subsidies were designed for employees whose employers did not provide plans, so the employees could buy private insurance.

Mission creep
Here is yet another problem, endemic to all government-funded programs: mission creep. The term, usually used to describe military operations that expand beyond their original goal, seems to be especially applicable here. For those who may be thinking the subsidies are pretty well-specified in PPACA and can't really be fooled with, think again. The Obama administration, contacted for comment by the Wall Street Journal (Jan. 30, 2013) says, "The issue is subject to regulations being written."

Ever since state-based, small group reform in the 1990s, it has been clear that while the legislatures set the table, it is the regulators who end up dictating the real-world implementation — and effects — of the laws. Regulations are where the rubber meets the road. Regulations are also the mother's milk of mission creep.

Many labor groups are concerned that if the subsidies are not expanded, unionized employers will drop coverage. "So what?" you ask. "This is the same conversation I am having with all of my employer groups." The salient difference is that current coverage for this population is provided as a benefit of being a member of a union. If that benefit is removed, organized labor worries it will lose a key membership driver that will, in turn, have a disastrous effect on their numbers.

In the coming months, there will be more instances of PPACA proponents learning their interests may be compromised as this expansive and ever-expanding law and its thousands upon thousands of pages of regulation move forward. Those folks should surf on over to YouTube to watch the E*Trade baby show his shocked face. Watch his expression. It's the same face you will see on those of us who knew these problems were an inevitable consequence of this legislation.