Topic: . - page 10. (Read 46178 times)

Affirm the dictates of the would be fascist dictator when they benefit you, contrary to his constitutional powers, as do others, soon that power is firmly cemented in place.

See what happens then.

Much easier to read history, lol...

I really hope this is true. I was fortunate to still continue with my noncompliant plan for another year. No matter what the news says. My plan was a good one-the ACA plan was terrible and a lot more expensive that the one I currently have.

Hundreds of people with HIV/AIDS in Louisiana trying to obtain coverage under President Barack Obama's healthcare reform are in danger of being thrown out of the insurance plan they selected in a dispute over federal subsidies and the interpretation of federal rules about preventing Obamacare fraud.

Some healthcare advocates see discrimination in the move, but Blue Cross and Blue Shield of Louisiana says it is not trying to keep people with HIV/AIDS from enrolling in one of its policies under the Affordable Care Act, also known as Obamacare.

The state's largest carrier is rejecting checks from a federal program designed to help these patients pay for AIDS drugs and insurance premiums, and has begun notifying customers that their enrollment in its Obamacare plans will be discontinued.

The carrier says it no longer will accept third-party payments, such as those under the 1990 Ryan White Act, which many people with HIV/AIDS use to pay their premiums.

"In no event will coverage be provided to any subscribers, as of March 1, 2014, unless the premiums are paid by the subscriber (or a relative) unless otherwise required by law," Blue Cross Blue Shield of Louisiana spokesman John Maginnis told Reuters.

AIDS FUNDS EXEMPT FROM FRAUD CONCERNS

The dispute goes back to a series of statements from Centers for Medicare and Medicaid Services (CMS), the lead Obamacare agency.

In September, CMS informed insurers that Ryan White funds "may be used to cover the cost of private health insurance premiums, deductibles, and co-payments" for Obamacare plans.

In November, however, it warned "hospitals, other healthcare providers, and other commercial entities" that it has "significant concerns" about their supporting premium payments and helping Obamacare consumers pay deductibles and other costs, citing the risk of fraud.

The insurers told healthcare advocates that the November guidance requires them to reject payments from the Ryan White program in order to combat fraud, said Robert Greenwald, managing director of the Legal Services Center of Harvard Law School, a position Louisiana Blue still maintains.

"As an anti-fraud measure, Blue Cross and Blue Shield of Louisiana has implemented a policy, across our individual health insurance market, of not accepting premium payments from any third parties who are not related" to the subscriber, Maginnis said.

On Friday, CMS spokeswoman Tasha Bradley told Reuters that, to the contrary, Ryan White grantees "may use funds to pay for premiums on behalf of eligible enrollees in Marketplace plans, when it is cost-effective for the Ryan White program," meaning that having people with HIV/AIDS enroll in insurance under Obamacare could save the government money.

"The third-party payer guidance CMS released (in November) does not apply to" Ryan White programs.


In this Wednesday, Dec. 11, 2013, file photo, Rosemary Cabelo uses a computer at a public library to …
Maginnis did not respond to further requests, sent after business hours, for comment on CMS's Friday statement.

Hundreds of indigent HIV/AIDS patients are dependent on Ryan White payments for Obamacare because they fall into a gap. They are not eligible for Medicaid, the joint federal-state health insurance program for the poor, because Louisiana did not expand the low-income program, and Obamacare federal subsidies don't kick in until people are at 100 percent of the federal poverty level.

Before Obamacare, the 1990 Ryan White Act offered people with HIV/AIDS federal financial help in paying for AIDS drugs and health insurance premiums, especially in state-run, high-risk pools.

Obamacare, which bans insurers from discriminating against people with preexisting conditions, was designed to replace these high-risk pools.

Starting on October 1, AIDS advocates and others in Louisiana "were enrolling anyone and everyone we could" through the Obamacare exchange, said Lucy Cordts of the New Orleans NO/AIDS Task Force.

Last month, her clients and those of other AIDS groups began to hear from Louisiana Blue that their enrollments were in limbo because the company would not accept the Ryan White checks for premium payments.

The only other carrier that is refusing to accept such payments is Blue Cross Blue Shield of North Dakota, according to a CMS official.

North Dakota Blue "restricts premium payment from third parties including employers, providers, and state agencies," said spokeswoman Andrea Dinneen, but "is currently reviewing its eligibility policies with respect to recipients of Ryan White Program funding."

'SURE LOOKS LIKE DISCRIMINATION'

Healthcare advocates are worried that the refusal to accept Ryan White payments is an effort by insurers to keep AIDS patients from enrolling in their plans and last month began pressing the issue, including with the office of Democratic Senator Mary Landrieu.

In an email reviewed by Reuters, a healthcare expert on Landrieu's staff wrote, "BCBS LA told me their decision was not due to the CMS guidance or any confusion (as we thought before) but was in fact due to adverse selection concerns. I have also recently learned North Dakota's BCBS plan has implemented the same policy."

Jessica Stone, the Landrieu staff member, declined to elaborate on the email further or to discuss her interactions with Louisiana Blue.

Adverse selection refers to the situation where an insurer attracts patients with chronic conditions and expensive care. Louisiana Blue's action "sure looks to us like discrimination against sick people," said John Peller, vice president for policy at the AIDS Foundation of Chicago.

Asked if it were engaging in efforts to avoid adverse selection by refusing to accept Ryan White payments for would-be customers with HIV/AIDS, Louisiana Blue said it was not trying to keep such customers out of its plans. "We welcome all Louisiana residents who chose Blue Cross and Blue Shield of Louisiana," said Maginnis.



http://news.yahoo.com/exclusive-aids-patients-obamacare-limbo-insurers-reject-checks-152316632--sector.html;_ylt=AwrBJR5rZPZSUBMAzhHQtDMD

Jail is Freedom!

The other side of this coin:
http://webcenters.netscape.compuserve.com/menu/

AOL?  Who dat?

AOL Chairman and CEO Tim Armstrong told CNBC this week Obamacare will cost the company $7.1 million and force it to cut other benefits.

“Obamacare is an additional $7.1 million expense for us as a company. So we have to decide whether to pass that expense to the employees or whether to cut other benefits.”

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/02/06/aol-chief-cuts-401k-benefits-blames-obamacare/

Being arrested in Chicago for, say, drug possession or assault gets you sent to the Cook County Jail to be fingerprinted, photographed and X-rayed. You’ll also get help applying for health insurance.

At least six states and counties from Maryland to Oregon’s Multnomah are getting inmates coverage under Obamacare and its expansion of Medicaid, the federal and state health-care program for the poor. The fledgling movement would shift to the federal government some of the more than $6.5 billion in annual state costs for treating prisoners. Proponents say it also will make recidivism rarer, because inmates released with coverage are more likely to get treatment for mental illness, substance abuse and other conditions that can lead them to crime.

“When someone gets discharged from the jail and they don’t have insurance and they don’t have a plan, we can pretty much set our watch to when we’re going see them again,” said Ben Breit, a spokesman for the Cook County Sheriff’s Office.

The still-small programs could reach a vast population: At the end of 2012, almost 7 million people in the U.S. were on parole, probation, in prison or locked up in jail, according to the federal Bureau of Justice Statistics. About 13 million people are booked into county jails each year, according to the Washington-based National Association of Counties.

Obamacare replaced a hodgepodge of state requirements that typically excluded childless adults from Medicaid. The 2010 law opened it to anyone making less than 138 percent of the federal poverty level, about $16,000 for an individual. In the 25 states that expanded the program under the Affordable Care Act, eligibility extends to many of the people most apt to be in jail or prison, said Fred Osher, director of health services and systems policy for the New York-based Council of State Governments Justice Center.

http://www.bloomberg.com/news/2014-02-06/jails-enroll-inmates-in-obamacare-to-pass-hospital-costs-to-u-s-.html

One guy ruined the plan after he purchased health insurance on the California exchange and then had the gall to call doctors to set up an appointment. His temerity drove him to call every doctor listed as in-network, and none of them were.

In the normal world, this would be called “fraud.” In Obama’s America, it’s called a “snag,” and on a national scale, the Obama regime labels it “Shut up, Fox News!”

After all, isn’t the goal getting everyone insured? Who cares if you can’t actually see a doctor or get health care, because everyone will get a terrific piece of paper that says “health insurance policy.” Equality, at last — everyone’s got the same thing; namely, nothing at all.

One California woman — an avowed Obama and Obamacare supporter, and cancer patient — was quite taken aback by the disaster.

Danielle Nelson dutifully enrolled in an Obamacare plan, and then went to see her oncologist, but was greeted at the door by a sign announcing they did not accept any Covered California plans.

http://www.bloomberg.com/news/2014-02-06/-doc-shock-reaches-the-masses.html

Truth is lies!

Obama Considering 3 Year Extension of His Decree Allowing People To Keep Their Health Plans Cancelled Because of Obamacare…



The Obama administration is considering an extension of the president’s decision to let people keep their individual insurance policies even if they are not compliant with the health care overhaul, according to two top industry officials.

Avalere Health CEO Dan Mendelson said Thursday that the administration may let policyholders keep that coverage for an additional three years, stressing that no decision has been made. Policymakers are waiting to see what rate hikes health insurers plan for the insurance exchanges that are key to the overhaul’s coverage expansions.

“The administration is entertaining a range of options to ensure that this individual market has stability to it and that would be one thing that they could do,” he said.

Avalere Health is a market analysis firm, but Mendelson said his company was not advising the administration on exchange policy. He said he has had informal discussions with administration officials about the extension, but he didn’t identify them.

http://bigstory.ap.org/article/admin-said-be-eyeing-insurance-extension

War is Peace!

Many consumers faced hurdles signing up for Covered California health plans. Now they're having trouble finding in-network doctors.



Maria Berumen uses a device to manage the pain from bone spurs on her spine. At least four doctors wouldn’t accept her health plan — even though the Covered California website and her insurer list them as part of her HMO network. (Katie Falkenberg, Los Angeles Times / January 30, 2014)


After overcoming website glitches and long waits to get Obamacare, some patients are now running into frustrating new roadblocks at the doctor's office.

A month into the most sweeping changes to healthcare in half a century, people are having trouble finding doctors at all, getting faulty information on which ones are covered and receiving little help from insurers swamped by new business.

Experts have warned for months that the logjam was inevitable. But the extent of the problems is taking by surprise many patients — and even doctors — as frustrations mount.

Aliso Viejo resident Danielle Nelson said Anthem Blue Cross promised half a dozen times that her oncologists would be covered under her new policy. She was diagnosed last year with non-Hodgkin's lymphoma and discovered a suspicious lump near her jaw in early January.

But when she went to her oncologist's office, she promptly encountered a bright orange sign saying that Covered California plans are not accepted.

"I'm a complete fan of the Affordable Care Act, but now I can't sleep at night," Nelson said. "I can't imagine this is how President Obama wanted it to happen."

To hold down premiums under the healthcare law, major insurers have sharply cut the number of doctors and hospitals available to patients in the state's new health insurance market.

Now those limited options are becoming clearer, and California officials say they are receiving more consumer complaints about access to medical providers. State lawmakers are also moving swiftly to ease some of the problems that have arisen.

"It's a little early for anyone to know how widespread and deep this problem is," said California Insurance Commissioner Dave Jones. "There are a lot of economic incentives for health insurers to narrow their networks, but if they go too far, people won't have access to care. Network adequacy will be a big issue in 2014."

The latest travails come at a crucial time during the rollout of Obama's signature law. Government exchanges and other supporters of the healthcare law are trying to boost enrollment, particularly among young and healthy people, ahead of a March 31 deadline.

Of course, complaints about outdated provider lists and delays in getting a doctor's appointment were common long before the healthcare law was enacted. But some experts worry the influx of newly insured patients and the cost-cutting strategies of health plans may further strain the system.

Maria Berumen, a tax preparer in Downey, was uninsured for years because of preexisting conditions. The 53-year-old was thrilled to find coverage for herself and her husband for $148 a month after qualifying for a big government subsidy.

She jumped at the chance in early January to visit a primary-care doctor for long-running numbness in her arm and shoulder as a result of bone spurs on her spine. The doctor referred her to a specialist, and problems ensued. At least four doctors wouldn't accept her health plan — even though the state exchange website and her insurer, Health Net Inc., list them as part of her HMO network.

"It's a phantom network," Berumen said.

It was no surprise to her family doctor, Ragaa Iskarous. She has run into this problem repeatedly with other patients in the last month, the doctor said. "This is really driving us crazy."

Berumen said she was seen by a neurosurgeon Thursday — after state regulators intervened on her behalf.

Insurers say they are working hard to resolve customers' problems as they arise, and they continue to add physicians to augment certain geographic areas and medical specialties.

"Any huge implementation like this comes with a lot of moving parts," said Health Net spokesman Brad Kieffer. "There is a learning curve for everyone, and we expect as time goes on these issues should dissipate."

Looking to head off potential problems, government regulators and patient advocates are pushing for tougher rules to ensure health plans provide timely access to care.

http://www.latimes.com/business/la-fi-obamacare-patients-20140205,0,1675336,full.story

Less Is More!

A decline in employment resulting from Obamacare means more choice, entrepreneurship and will result in a more “dynamic” jobs market, a chief White House economist said. He further said fewer people will choose to work because of Obamacare, the same as fewer senior citizens choose to work because of Social Security and Medicare.

Jason Furman, chairman of the Council of Economic Advisors, stressed that the Congressional Budget Office prediction by the Congressional Budget Office that 2.5 million people will leave the work force by 2024 as a result of the Affordable Care Act is a positive thing.

“This is a choice on a part of workers,” Furman told reporters Tuesday. “I have no doubt, if for example, we got rid of Social Security, and Medicare, there are many 95-year-olds who would choose to work more to avoid potentially starving or to give themselves the opportunity to get health care, I don’t think anyone would say that’s a compelling argument to eliminate Social Security and Medicare.”

The Obamacare law provides insurance subsidies and expands Medicaid allowing people to avoid “joblock,” or working somewhere just to maintain health insurance, Furman said.

“Similarly, here, CBOs analysis itself is about the choices that workers are making in the face of new options available to them by the Affordable Care Act, not something that about firms destroying jobs,” Furman said.

One reporter later asked, “Doesn’t that incentivize some people to do less because all of a sudden there is an incentive to do less because if there salary is less they still get a government subsidy and benefit?”

Furman disagreed.

“First of all, for many people, this potentially an incentive to do more,” he responded. “An incentive for more entrepreneurship because they’re not locked into a job, there’s an incentive for employers to hire more people because the cost of health care is lower.”

Furman added, “The Affordable Care Act essentially solves that and creates a situation where you can be more dynamic.”


http://www.theblaze.com/stories/2014/02/04/heres-how-the-white-house-is-attempting-to-spin-damaging-nonpartisan-cbo-report-on-obamacare/


2.5 Million Fewer Workers From ObamaCare A Small Part Of Economy:
http://youtu.be/Dmyd6aUDPwc

U.S. intelligence agencies last week urged the Obama administration to check its new healthcare network for malicious software after learning that developers linked to the Belarus government helped produce the website, raising fresh concerns that private data posted by millions of Americans will be compromised.

The intelligence agencies notified the Department of Health and Human Services, the agency in charge of the Healthcare.gov network, about their concerns last week. Specifically, officials warned that programmers in Belarus, a former Soviet republic closely allied with Russia, were suspected of inserting malicious code that could be used for cyber attacks, according to U.S. officials familiar with the concerns.

The software links the millions of Americans who signed up for Obamacare to the federal government and more than 300 medical institutions and healthcare providers.

“The U.S. Affordable Care Act software was written in part in Belarus by software developers under state control, and that makes the software a potential target for cyber attacks,” one official said.

http://freebeacon.com/the-belarusian-connection/


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http://youtu.be/ppNymgdStR4

Former Republican state Rep. Patrick Sheehan told the KATU Investigators he has gone to the FBI with allegations that Cover Oregon project managers initiated the design of dummy web pages to convince the federal government the project was further along than it actually was.

If Sheehan’s allegations are true, those managers could face time in jail for fraud.

“One of the allegations that was made was so alarming that it went way beyond a legislative oversight committee and so I did reach out and contact the FBI,” Sheehan said.

“The issue had to do with federal funding and proving some amount of compliance with the federal regulation in order to get funding.”


[...]
What that meant for the Cover Oregon website was that it was able to paint a picture of a flashy website – imagine a concept car that looks flashy in the showroom but doesn’t actually run.

But documents uncovered by the KATU Investigators show Lawson hadn’t actually figured out how to build the site, even as she was promising the federal government – and her bosses – that Cover Oregon’s website was going to work.

So what, exactly, were the federal and state reviewers being shown?

In a Sept. 27, 2012 email to Bruce Goldberg – Lawson’s boss at the Oregon Health Authority, who is now in charge of Cover Oregon – she sent a link to something called “The Solution Factory,” a site hosted by software contractor Oracle.

Lawson wrote in the email that the link went to a site hosting the same demonstrations the team provided to project stakeholders.

“It demonstrates what we have built to date,” she wrote. “By watching this every month, you can see our progress in real time.”

http://www.katu.com/news/investigators/Cover-Oregon-allegation-if-its-true-someones-going-to-prison-243427781.html?tab=video&c=y
---------------------------------------------------------------------------------

Watch the video.

I'll just leave this here.

sub·si·dy
noun \ˈsəb-sə-dē, -zə-\

: money that is paid usually by a government to keep the price of a product or service low or to help a business or organization to continue to function
-----------------------------

 +.9% Increase in Medicare Tax Rate (plus next item…) 
    3.8% New Tax on unearned income for high-income taxpayers= $210.2 billion ($200,000 for individual and $250,000 for joint filers)
    New Annual Fee on health insurance providers = $60 billion (For calculation - Sec 9010 (b) of the PPACA.)[1]
    40% New Tax on health insurance policies which cost more than $10,200 for an individual or $27,500 for a family, per year = $32 billion (inland tax as opposed to an importation tax)
    New Annual Fee on manufacturers and importers of branded drugs = $27 billion (For calculation - Sec 9008 (b) of the PPACA)[2]
    2.3% New Tax on manufacturers and importers of certain medical devices = $20 billion
    +2.5% Increase (7.5% to 10%) in the Adjusted Gross Income floor on medical expenses deduction = $15.2 billion
    Limit annual contributions to $2,500 on flexible spending arrangements in cafeteria plans (plans that allow employees to choose between different types of benefits) = $13 billion
    All other revenue sources = $14.9 billion
        10% New Tax imposed on each individual for whom “indoor tanning services” are performed.
        3.8% New Tax on investment income. Includes: gross income from interest, dividends, royalties, rents, and net capital gains. Investment income does not include interest on tax-exempt bonds, veterans’ benefits, excluded gain from the sale of a principle residence, distributions from retirement plans, or amounts subject to self-employment taxes. (The lesser of net investment income or the excess of modified Adjusted Gross Income over a the dollar amount at which the highest income tax bracket, typically $250,000 for married filing jointly and $200,000 filing as an individual).

They are wrong.  Their analysis only holds true as long as the US government can keep interest rates at or near zero, allowing the printing of money for programs of this sort that benefit classes of the voting public.

Socialist or communist backed by tight fisted budget directors can endure for a while; neither collectivist, fascist or superficially capitalist society will endure long with magnificent cash giveaways for political purposes.

This is why every single advocate of US federal health plans is wrong, and why across the board attempts at comparisons with other countries' health plans are nothing but shallow polemics.





 

Executive Summary
1. The Affordable Care Act (ACA) will improve the well-being and incomes of Americans in the bottom fifth of the income distribution. Under our broadest and most comprehensive income measure we project that incomes in the bottom one-fifth of the distribution will increase almost 6%; those in the bottom one-tenth of the distribution will rise more than 7%. These estimated gains represent averages. Most people already have insurance coverage that will be left largely unaffected by reform. Those who gain subsidized insurance will see bigger percentage gains in their income.

2. The gains in well-being at the bottom are hardly surprising. The goal of the ACA is to make health coverage more affordable by reforming insurance arrangements and by subsidizing the insurance purchases of low- and moderate-income families. The new subsidies will come through an expansion of Medicaid and the introduction of refundable tax credits for the purchase of insurance through new state Exchanges. Because Medicaid is costless to the low-income population and since the refundable tax credits will be restricted to families with incomes below 400% of the poverty line, the great majority of the beneficiaries of the new government spending will be in the bottom half of the income distribution. Our estimates suggest, in fact, that the overwhelming majority will be in the bottom one-third of the distribution.

3. Our analysis also shows, however, that the estimated gains and losses are crucially affected by the definition of household income. The most widely used measure—the Census Bureau’s “money income” measure—does not count health insurance as income. Under this definition, the ACA has small effects on income, including those at the very bottom of the income distribution. (Some at the bottom may see a slight decline in their money incomes; others will see an income gain.) Even when we use a somewhat more expansive definition of income—one that counts part of the value of insurance—Americans in the bottom tenth of the distribution gain little, but this startling result says more about the way income is defined than it does about how the ACA affects low-income households.

4. The finding that the ACA will not have much effect on standard estimates of poor Americans’ incomes is easily explained. It is a byproduct of the way “money income” is defined. The definition includes pre-tax money wages, net self-employment earnings, pensions, government cash transfers (such as Social Security and unemployment compensation), interest, dividends, rent payments, and other regular and irregular cash income flows. It does not include the health insurance contributions employers make for their workers. Nor does it include government spending on health plans, such as Medicaid and Medicare, which pay for most or all of the health care of the people who are insured. Employers and the government currently spend about $1.5 trillion—13% of total personal income—paying our health care bills. The ACA will increase public spending to help low- and moderate-income people pay their medical bills. If we use a definition that doesn’t count the extra spending as “income,” household incomes obviously will not change very much.

5. Experts recognize the shortcomings of income definitions that exclude health insurance. But figuring out how to include it poses a challenge. To include the value of free or subsidized health protection in income statistics, the Census Bureau sometimes uses a concept called “fungible income.” The fungible value of insurance includes the full premium contribution made by employers in behalf of their workers. It also includes some or all the subsidies provided by the government to participants in public health plans, but only for families who have enough cash income to pay for basic food and housing. If income exceeds this threshold, then part or all of the value of government financed health benefits is included. When families don’t have enough cash income to pay for basic food and shelter needs, none of the value of government insurance is counted as income. The key point is that the “fungible income” approach assigns to low income households little or no income value from publicly financed health benefits.

6. Only when we count as income the full cost to the government of providing additional health insurance to the poor does the ACA have a meaningful and positive impact on the post-ACA incomes of the very poor.

7. The benefits of the ACA to low-income families would have been greater if the enacted version of the law had been put into effect. The Supreme Court’s ACA ruling in 2012 means that states cannot be compelled to expand eligibility limits for Medicaid as Congress intended. Slightly more than half the states have decided to raise income limits for Medicaid, but 23 states have declined to do so. Low-income children and adults in those states who were not previously eligible for Medicaid will remain ineligible. The Supreme Court decision combined with state inaction means the impact of the ACA on insurance enrollment among Americans’ with the lowest incomes will be smaller than would otherwise be the case. An additional 6% of Americans in the lowest money income quintile would have obtained health coverage if the enacted version of the ACA had gone into effect.

8. Following the projections of the CBO and other forecasters, we anticipate small net declines of enrollment in employer-sponsored health insurance. Some workers will gain employer coverage, and others will enroll in existing employer plans because they face penalties if they don’t have coverage. However, some employers may drop coverage for part-time employees, and some workers will leave their employer plans because less expensive coverage will be available elsewhere (for example, under Medicaid). On net, we expect enrollment in employer plans to shrink 5.9 million, or about 3½%, in the population under 65.

9. We expect the changes in employer coverage to have effects on money income as well as on income measured under more comprehensive definitions. If employers’ health costs fall, many will pass most of the savings along to their workers in the form of higher money wages. If employer health costs rise, we expect them to cut cash wages so their compensation costs remain roughly unchanged. The impact of the ACA on employer coverage varies by income decile; so do its effects on money wages.

10. On balance our projections indicate the shifts in employer coverage will slightly reduce money wages in many parts of the income distribution but increase wages in the bottom quarter and top one-fifth of the distribution. Many workers with modest incomes will find it cheaper to obtain subsidized plans through the Exchanges or free Medicaid coverage than to continue their employer-based coverage. When they leave employer plans, they generate cost savings for their employers—assuming their employers do not have to pay penalties to the government. This will allow their employers to increase money wages. Money wage gains are more common for families with incomes between the 10th and the 25th percentiles and above the 80th percentile than they are in other parts of the income distribution. We therefore project families in these income ranges will see increases in their money incomes. Between the 25th and 80th income percentiles, we project money wages will decline modestly.

11. Under more comprehensive income definitions—ones that include the value of health insurance—most workers’ money wage gains and losses are exactly offset by corresponding losses or gains in the value of their employer health protection. However, those workers who substitute subsidized government insurance for an employer health plan typically see a net gain in income under comprehensive income definitions.

12. The ACA contains a variety of provisions to offset the extra cost to the government of boosting Medicaid enrollment and providing new tax credits for insurance purchase. We include some of the biggest items in our analysis. The ACA cut federal subsidies to Medicare Advantage plans. It increased Part B and Part D Medicare premiums for high-income enrollees. The law imposed a higher Medicare payroll tax and a new investment tax on high-income taxpayers. In addition, the law imposes income-related penalty payments on nonpoor families not covered by health insurance and on mid-size and large employers which do not offer affordable insurance to their full-time workforce. The Medicare premium increases and the tax hikes reduce the net incomes of high-income Americans, but the anticipated cut in Medicare Advantage subsidies will affect the net value of those plans for everyone enrolled in them. Also, except at the very bottom of the distribution we project that penalty charges will also affect the net incomes of some families in most parts of the distribution.

13. On net and under the broadest income measure, the gains and losses cause small proportional drops in income for Americans in the top three-quarters of the income distribution which offset the larger proportional gains obtained by Americans in the bottom quarter of the distribution. The drop in employer contributions to health plans offsets some of the gains in projected government health subsidies, mainly to Americans at the bottom of the distribution. The projected drop in federal subsidies to Medicare Advantage plans reduces the subsidies received by participants in those plans. Higher Medicare premiums, Medicare payroll tax contributions, and the new investment tax cut net incomes of Americans, especially elderly Americans, at the top of the distribution. Americans under 25, especially those at the bottom of the distribution, enjoy income gains associated with broader and government-subsidized insurance coverage.

http://www.brookings.edu/research/papers/2014/01/potential-effects-affordable-care-act-income-inequality-aaron-burtless