Mark this day, June 25,2015 (also my daughter’s 10th birthday) as also the birth of a new state. Our country, according to the Supreme Court’s decision in King v. Burwell, now consists of 51 states. The Health and Human Services (HHS) is now our 51st state.
Today the Supreme Court decided the King v. Burwell case.
If you recall, this case was to determine whether the plain language of the Affordable Care Act (ACA) should be upheld. According to the ACA, people were to receive tax subsidies or “premium tax credits” to subsidize certain purchases of health insurance made on Exchanges, but only those enrolled in through an Exchange established by the State under [§18031]. §36B(c)(2)(A).
“Specifically, the question presented is whether the Act’s tax credits are available in States that have a Federal Exchange.”
“At this point, 16 States and the District of Columbia have established their own Exchanges; the other 34 States have elected to have HHS do so.”
In Justice Scalia’s words, “This case requires us to decide whether someone who buys insurance on an Exchange established by the Secretary gets tax credits. You would think the answer would be obvious—so obvious there would hardly be a need for the Supreme Court to hear a case about it. In order to receive any money under §36B, an individual must enroll in an insurance plan through an “Exchange established by the State.” The Secretary of Health and Human Services is not a State. So an Exchange established by the Secretary is not an Exchange established by the State—which means people who buy health insurance through such an Exchange get no money under §36B.”
However, the majority disagrees.
Apparently, HHS is now our 51st state.
The upshot of the Decision is that the majority found that, despite our country’s deep-rooted, case law precedent that when a statute is unambiguous that the plain meaning of the statute prevails. Despite hundreds of years of the Supreme Court upholding statutes’ clear meanings, the Supreme Court, in this case, decided that “[i]n extraordinary cases, however, there may be reason to hesitate before concluding that Congress has intended such an implicit delegation.”
Therefore, when the ACA became law, and the word “state” was used, surely, Congress meant “state and/or federal government.” Or, on the other hand, let’s just call HHS a state for the purpose of the ACA.
In Justices Scalia, Thomas, and Alito’s opinions, the decision is absurd. In the dissent they write, “The Court holds that when the Patient Protection and Affordable Care Act says “Exchange established by the State” it means “Exchange established by the State or the Federal Government.” That is of course quite absurd, and the Court’s 21 pages of explanation make it no less so.”
Well, folks, it is official. I am “over the hill.” Yup. My birthday is today, January 7, 1975, and I was born 40 years ago.
Instead of moping around, I have decided to embrace my 40s. For starters, let’s take a look at where we were 40 years ago. Obviously, personally, I was in utero. But what about the country? What about health care?
Not surprisingly, even 40 years ago, politicians were discussing the same issues with health care as we are now. Some things never change…or do they???
In my “40 years in review” blog, I want to discuss why we, as a nation, are still arguing about the same health care issues that we were arguing about 40 years ago. And, perhaps, the reason why we have been in a 40-year-old stalemate in health care reform.
Today, we have a diverged nation when it comes to health care. Democrats want to expand public health insurance (i.e., Medicaid) and tend to favor a higher degree of government oversight of health care to ensure that health care is available to all people. Republicans, on the other hand, believe that the financial burden of the Affordable Care Act (ACA) on the federal and state level is unsustainable, and people will receive less than adequate health care. Republicans tend to favor privatization of Medicaid, while liberals oppose such ideas.
Health care reform has been a hot topic for over 40 years…with some interesting differences…
Going back to 1975…
Gerald Ford, a Republican, was our nation’s president, and we were in a nationwide recession.
Under Ford, the American Medical Society (AMA) proposed a new plan for health care, an employer mandate proposal.
According to a 1975 Chicago Tribune journalist, the AMA’s new proposal pushed for a broader government role in health care. See below.
“The new [ ] plan would cover both employees and the unemployed, along with poor people and those considered uninsurable because of medical or mental problems. It would require employers to subsidize health care for employees and their families and pay at least 65 % of each premium. It would also require the government to provide partially subsidized health insurance, financed from general revenues, for the poor and the unemployed. It calls for medical insurance benefits covering 365 days of hospital care during any one year, 100 days of nursing home care, and home health, mental, and dental service for children aged 2 and up. All but the poorest beneficiaries would share premium costs and would pay 20 per cent for the services provided, but no individual would pay more than $1,500 a year and no family more than $2,000 a year for health care.”
Chicago Tribune, “The A.M.A.’s subsidy plan” April 19, 1975 (emphasis added) (no author was cited).
Interestingly, in that same newspaper from April 19, 1975, advertisements show towels for $1.89, pants for teenagers for $4.99, a swivel rocker for $88, and a BBQ grill for $12.88. My how times have changed!
Those prices also indicate how much buying power was involved with the AMA’s proposal, and what it meant to suggest that an individual might have to pay up to $1,500 a year, and a family up to $2,000 a year, for health care – a lot of money back then!
In 1976, Pres. Ford proposed adding catastrophic coverage to Medicare, offset by increased cost sharing. These are examples of Pres. Ford (a Republican) creating more government involvement in health care and expanding health care to everyone.
After Pres. Ford, came Pres. Jimmy Carter from 1977-1981, a Democrat.
Pres. Carter campaigned on the notion of “universal health care for everyone;” however, once in office he decided instead to rein in costs, and not expand coverage. In the prior decade (1960), the consumer price index had increased by 79.7%, while hospital costs had risen 237%. President Carter proposed an across-the-board cap on hospital charges that would limit annual increases to 1.5 times any rise in the consumer price index.
Pres. Carter was also quoted from public speeches saying, “We must clean up the disgraceful Medicaid scandals.”
Pres. Carter’s stance on “universal” health care was: “that such a program would be financed through both the employer and the payroll taxes, as well as general revenue taxes. Patients would still be free to choose their own physician, but the federal government would set doctor’s fees and establish controls to monitor the cost and quality of health care.”
In May 1979, Senator Ted Kennedy, a Democrat, proposed a new universal national health insurance bill—offering a choice of competing federally-regulated private health insurance plans with no cost sharing financed by income-based premiums via an employer mandate and individual mandate, replacement of Medicaid by government payment of premiums to private insurers, and enhancement of Medicare by adding prescription drug coverage and eliminating premiums and cost sharing.
These are examples of Democrats, Pres. Carter, by not expanding health care coverage and reining in costs, and Sen. Kennedy, by proposing privatization of Medicaid, acting in a more conservative nature, or, as a conservative nature would be perceived today.
So when did the parties flip-flop? Why did the parties flip-flop? And the most important question…if we have been struggling with the exact same issues on health care for over 40 years, why has our health care system not been fixed? There has certainly been enough time, ideas, and proposed bills.
While I do not profess to know the answer, my personal opinion is the severe and debilitating polarizations of the two main political parties have rendered this country into a 40-year-old stalemate when it comes to health care reform and are the reason why the solution has not been adopted and put into practice.
Maybe back in 1979, when Senator Kennedy proposed replacing Medicaid with private insurance, Republicans refused to agree, simply because a Democrat proposed the legislation.
Today when Republican candidates campaign on privatizing Medicaid and the Democrats vehemently oppose such action, maybe the opposition is not to the idea, but to the party making the proposal.
Just a thought…
And here’s to the next 40!!!
A lawsuit that could come out as early as tomorrow could be catastrophic for the Affordable Care Act (ACA) in as many as 36 states and impact approximately 5.4 million Americans.
In so many ways, in the last year or so, the all-changing, great and powerful ACA that promised affordable health care for all and “if you like your health care coverage, you can keep it,” has fallen monumentally short of its original, lofty promises.
In a way, we all wanted to believe in the promises of the ACA, like Dorothy in “The Wizard of Oz.” Who can forget the disappointed sigh Dorothy expels when Toto pulls back the curtain of the Great and Powerful Oz only to see a mundane, elderly man with absolutely no super powers or means to grant her wishes. Dorothy wanted Oz to be real. She wanted desperately for Oz to be as Great and Powerful as he proclaimed. However, in reality, he was not.
Like Dorothy wanted Oz to be real, we all wanted the ACA to create an affordable, nationwide health care system…this health care utopia.
So many lofty promises of the ACA have already been crushed, either by the Supreme Court’s decision that allows states to opt-out of Medicaid expansion, or by President Obama himself in executive actions, including an action delaying the employee mandate.
The courts may deflate the illusions of grandeur of the ACA even more with an upcoming and anxiously awaited decision. The case of Halbig v. Burwell, a D.C. Court of Appeals case, has concerned citizens everywhere, who wait on bated breath for a ruling. Halbig could have a huge (negative) impact on health care premiums. Halbig could be the Toto that pulled back the curtain on the ACA.
Let me explain:
There is a subsection of the ACA that allows high insurance premium tax credits, in an effort to make premiums more affordable for low-income families. The subsection applies to individuals who make less than $46,075. In implementing the ACA, it was contemplated that those individuals who make under $46,075 will have difficulty affording the insurance premiums; therefore, the ACA gives nice, large tax credits to offset the costs of premiums.
However, according to the plain language of the statute, these tax credits only apply to those individuals enrolled “through an exchange established by the state.” (emphasis added). Yet two-thirds (or 36) of the states did not establish state-run health care exchanges (including NC). Instead, these states relied on the federal exchange, in part, to avoid additional cost expenditures.
Here is a map of states according to whether it is expanding Medicaid:
The Halbig case asks the question: Can people living in states run by a federal health exchange reap the benefit of tax credits intended for those people participating in an exchange run by the state?
If the Halbig Court takes that stance that the statute is not ambivalent and must be followed exactly as it is written, then millions of Americans will become ineligible for the tax credits for health care premiums, because they will not be enrolled in a state-run exchange. Premiums would sky-rocket and many Americans would be unable to afford health care…again. It is estimated that without the tax credits, the health care premiums will cost 4x as much.
Interestingly, the Internal Revenue Service (IRS) weighed in and issued a highly-contested rule authorizing the federal exchange to issue tax credits. Amidst all the tomfoolery about the IRS targeting 501(c) charities owned by the Tea Party, it is surprising, at least to me, that the IRS would issue such a contentious ruling in favor of the ACA and anti-conservatives.
Hence, the Halbig case, in which Plaintiffs argue that the IRS has exceeded its statutory authority in issuing tax credits to those residing in states with federal exchanges, when the ACA clearly states that the tax credits only apply to state-run exchanges.
If the D.C. Court of Appeals sides in favor of the Plaintiffs, the following could occur:
• Residents of 36 states could pay health care premiums 4x more than promised;
• The ACA would fall short of promises…again;
• The IRS will have exceeded its authority to benefit Democrats…again;
• People may not be able to afford the health care premiums;
• The ACA could risk the downfall of many more promises.
We all wanted the ACA to create health care utopia. We all wanted the Great and Powerful Oz to be Great and Powerful.
But the courts may tell us we just can’t say, “Pay no attention to the man behind the curtain!!”
BNA’s Health Care Policy Report:
Posted March 5, 2014
The Obama administration March 5 said consumers can keep their health plans that don’t comply with the Affordable Care Act for two more years, as part of a release of new ACA rules and policies.
The Department of Health and Human Services noted that in fall 2013, the administration extended through 2014 noncompliant health plans in the small group and individual health insurance markets, for insurers that received permission from their state to do so. Now, the department is extending its “transitional policy for two years,” to policy years beginning on or before Oct. 1, 2016.
“This gives consumers in the individual and small group markets the choice of staying in their plan or joining a new Marketplace plan as the new system is fully implemented,” the HHS said.
The HHS also issued a comprehensive ACA insurance markets rule (CMS-9954-F) called the Notice of Benefit and Payment Parameters for 2015. The regulation includes provisions on premium stabilization; open enrollment for 2015; annual limitations on cost sharing; consumer protections; financial oversight; and the Small Business Health Options Program, or SHOP.
For the temporary “risk corridors program,” which helps stabilize premiums when enrollees are much sicker or much healthier than expected, the HHS said it intends to operate the program in a budget-neutral manner, with payments coming in equaling the amount of money going out, “while helping to ensure that prices remain affordable in 2015 and beyond.”
The Treasury Department and the Internal Revenue Service also released final rules (TD 9661) March 5 to implement the information reporting provisions for insurers and certain employers under the ACA that take effect in 2015. Treasury said the final rules on information reporting by employers “will substantially streamline reporting requirements for employers, particularly those that offer highly affordable coverage to full-time employees.” Treasury also released final rules (TD 9660) to provide guidance for reporting by insurers and other parties that provide health coverage under the ACA.
An HHS bulletin on the plan extension is at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/transition-to-compliant-policies-03-06-2015.pdf. The HHS and Treasury rules are posted at the public inspection website: http://www.federalregister.gov/public-inspection.
I randomly picked up Wednesday’s copy of “Indy” in a coffee shop. The title caught my eye, “The Legislature’s Disgraceful Two Weeks.” I mean, Wow. That’s quite a title! So, of course, I had to pick it up.
I turned to page 7 and read the “Block Obamacare” paragraph and almost choked when I read the paragraph. The statements written were patently untrue. Forgive my naivety, but isn’t there some sort of oath for journalists to at least attempt to state the truth?
I felt obligated to explain how the Indy failed to publish the correct facts.
First sentence: “The Affordable Health Care Act would extend Medicaid (government health insurance for poor people) to 500,000 North Carolinians who don’t currently qualify – at essentially no cost to the State.”
No cost to the State??? Seriously? Where did these facts come from??? Reality: According to an economic study in the New York Times, should North Carolina expand Medicaid, between 2014-2019, North Carolina would have to contribute approximately $1.029 Billion. Yes, Billion!!! If you think $1.029 billion is “essentially no cost,” please send me a check for a few million. Make it out to my name please.
Second sentence: “Nonetheless, Senate and House Republicans have said they don’t want the money.”
What? They don’t want the money? The sentence makes it sounds like the federal government is passing around a basket full of money and asking the states to take what they want. Not only is this sentence incorrect, it is misleading. There is no free basket full of money for everyone. And no one in the General Assembly (I feel confident this is correct, although it has not been corroborated) is refusing free money.
The choice to not expand Medicaid is predicated on a plethora of reasons. One reason off the top of my head, is that, according to the recent audit conducted on DMA, yearly, DMA spent approximately $648.8 million on administration costs. Proponents of Medicaid expansion have said that Medicaid expansion would create jobs. Guess where? DMA. Let’s ADD to the administration costs instead of reeling them in….Really???? This is similar to the mentality I had as a teenager: I know I’m doing something wrong, but unless my parents find out, so what?
Third sentence: “The bill to block the expansion is en route to the House with the backing of Gov. Pat McCrory.”
Ok, that was the only sentence somewhat true with one large difference. In reality, Gov. McCrory has been extremely hesitant to rush the decision of whether to expand Medicaid. He urged lawmakers not to rush.
So after reading the paragraph preceding the article, I was terrified to actually read the article. But much like a train wreck happening in front of you, I couldn’t resist.
My favorite line: “It’s long been apparent that Republicans should have no credibility on the question of fiscal prudence.”
Once I read that sentence, I laughed out loud. Obviously, this journalist suffers from extreme parochial vision and has made the topic a “Republicans v. Democrats” debate. People, who cares what political side you are on? Medicaid recipients deserve quality care and enough health care providers to care for the entire Medicaid population (currently around 1.5 million in North Carolina). Right now, in North Carolina, Medicaid recipients cannot find physicians, psychologists, dentists, or specialty physicians willing to accept Medicaid patients.
Enable the 1.5 million North Carolinians, to whom we owe a duty to provide health care, to receive quality health care. Personally, if I were on the cusp of receiving Medicaid, and I knew that, through Medicaid expansion, I could get the Medicaid card, but not find a doctor willing to accept me (or if I found one to accept me that I wouldn’t get all the tests or procedures that someone with private insurance would undergo), I would choose to say, “No, to unequal health care.”
Medicaid eligibility. Just the phrase itself raises so many questions:
The Medicaid system, like our tax system, is esoteric. So, the purpose of today’s blog is set out some much-needed facts.
First, Medicaid eligibility, as of today, can be found in an extremely detailed, yet hard to understand, chart on the Department of Health and Human Services‘ (DHHS) website. Click here. But don’t say I didn’t warn you.
Under the federal health care law, should NC choose to accept the federal dollars, eligibility for government-backed Medicaid may be expanded in 2014 to anyone making below 138 percent of the federal poverty level. Here’s who would qualify:
Family size: Income level
1 person: $15,414
2 people: $20,879
3 people: $26,344
4 people: $31,809
So there is it: The Medicaid eligibility requirements currently and if NC accepts federal dollars.
It is important to note that, on Tuesday, February 12, 2013, Governor McCrory endorsed a measure to prevent major components of the federal health care law from taking effect in North Carolina. Merely hours after McCrory’s announcement, the measure won easy approval in a House committee. The full House will consider the legislation quickly.
I will devote another blog to the effects of reform versus expansion. Today, I only wanted to get the eligibility requirements out.
This blog is dedicated to North Carolina Medicaid. However, per Obamacare, in the future, the Medicaid reimbursements rates will be in direct correlation to the federal Medicare reimbursement rates. Therefore, Medicare reimbursement rates are important to Medicaid.
Earlier this month, Congress was forced to tangle with the “fiscal cliff.” I’m sure everyone, as well as myself, is grateful, mostly because we were sick of hearing the term, “fiscal cliff.”
A lesser-known component of Congress’ fiscal cliff avoidance is that Congress, once again, thwarted the annual threat of Medicare reimbursement rates to physicians getting cut by 26.5%. Of course, per Congress’ normal course of business, the avoided rate cut is only a temporary fix. Next year, again, we will be faced with the same threat. Since 2003, annually, Congress must decide whether to allow the Medicare reimbursement rates to physicians to be reduced. So far, every year, Congress has prevented the Medicare reimbursement rates to be slashed. So why not pass legislation that puts an end to the annual debacle? I, for one, actually thought this year Congress may do just that while they were tangling with the fiscal cliff. But no such luck.
If you have been following my blog, or read any of my past blogs, then you know that I am a huge advocate of higher reimbursement rates for physicians who accept Medicaid. Not enough physicians accept Medicaid for the number of Medicaid recipients. Medicaid recipients have the right to receive quality medical health care. With the Medicaid reimbursement rates so low, many physicians refuse to accept Medicaid patients, and those that do accept Medicaid often refuse to run expensive tests due to the Medicaid reimbursement rate.
With that said, Congress thwarting the Medicare rate reduction again this year is a good thing. Reimbursement rates need to increase, not decrease.
However, let’s not cheer on Congress too much for their temporary fix on not reducing the Medicare reimburse rates. Remember, I said that the reduction rate this year was supposed to be 26.5%.
How much did this temporary hold on Medicare reimbursements rates cost? According to federal budget officials, the cost of stopping the 2013 Medicare physician payment reduction is $7 billion for a one-year pay patch.
So…Yay for the temporary hold on Medicare reimbursement rates….But, where did the $7 billion come from?
Quick evaluation of necessary services for Medicaid recipients:
1. Physicians accepting Medicaid
2. Hospitals accepting Medicaid
Think about it. If a Medicaid recipient cannot locate a physician accepting Medicaid, the recipient has little choice but to check in at the local emergency room. Hospitals ERs, sadly, become the Medicaid recipients’ primary care doctor in the absence of one accepting Medicaid. (Didn’t you wonder why it takes 5 hours to be seen at the ER?)
Back to the $7 billion:
U.S. hospitals will be footing most of the bill for $7 billion. While Congress averted the fiscal cliff and a slash to Medicare reimbursement rates, Congress slashed the Medicare reimbursement rate to hospitals. The legislation cuts Medicare payments to hospitals for taking care of patients overnight and as inpatients to the tune of about $10.5 billion over 10 years. It also reduces subsidies for some pharmacies and some dialysis facilities.
Hmmmmm…so, by maintaining the status quo on Medicare reimbursements to physicians, hospitals that accept Medicare will suffer?
Why this makes zero sense: By maintaining status quo with physicians accepting Medicare, we are not increasing the number of physicians who accept Medicare. We are maintaining the number. If you agree with me that we desperately need more physicians accepting Medicare/caid, then maintaining status quo is not good enough. Plus, by understanding the Medicaid/care’s reliance on hospitals in light of few physicians accepting Medicare/caid, you understand that crippling hospitals accepting Medicare/caid is the opposite of what is needed by the Medicare/caid population. Congress essentially robbed Peter to pay Paul.
At some point, government officials are going to need to decide that Medicaid is important enough to really fix. When that happens, officials will realize that reimbursement rates need to be at a level which cause physicians and hospitals to opt to treat Medicaid recipients. Maintaining the current reimbursement rates is not acceptable. Neither is decreasing reimbursement rates to some health care providers to stop a decrease in reimbursement rates to another type of health care provider. If the Medicaid rates are tied to Medicare’s rates, then, obviously, we need to increase reimbursement rates to both.
I understand increasing the Medicaid reimbursement rates would be costly. But isn’t it also costly for North Carolina to have millions of Medicaid recipients without proper health care? With no physician who will accept Medicaid? And visiting the costly ER for services that a primary care physician could handle? Maybe the answer is that today’s Medicaid program is antiquated. Medicaid was created in 1965 with millions less Americans taking part in it. Maybe the Medicaid system was not created with the foresight of the number of Americans who would rely on it for medical insurance. Maybe 57 years after creation, we need to completely revamp the Medicaid system. I wonder whether a politician would ever have the guts to revamp the entire Medicaid system. And would he or she ever get elected????
Taxes? On health care? But, wait, I thought Obama was expanding Medicaid and allowing more citizens to be covered by Medicaid….Why would he tax the health care industry, which would cause more health care providers to refuse to accept Medicaid?
He has to. By enacting Obamacare and expanding Medicaid, the costs of the Medicaid expansion is staggering, approximately a $1.76 TRILLION between 2012-2021.
Where will the money come from?
Many places…but some places do not make much sense.
- A 2.3 percent sales tax on medical devices used by hospitals and doctors.
- $716 billion slashed from Medicare
- A possibility of new taxes on employer-sponsored health insurance
There are more places Obamacare is cutting budgets in order to finance the Medicaid expansion. But a critical look at these 3 places from which money is coming offers deep questions as to the logic of expanding Medicaid while taxing the very services and health care entities needed to service Medicaid recipients.
Sales tax on medical devices used by hospitals and
While a 2.3% tax increase on medical devices may not sound ominous, think of this: This sales tax is excised whether or not the medical company turns a profit or suffers a loss. The tax will hit every single medical device imaginable, from pacemakers, to X-ray machines, to prosthetics. It is estimated that this tax could yield approximately $29 billion. The manufacturing companies will NOT pick up this tab. No way! The manufacturing companies will raise the prices on medical devices or terminate workers. With unemployment at its current rate, it is illogical to tax medical device companies, who we know, in return, will terminate workers and increase the cost of health care. It seems to be the repercussions of enacting tax laws that negatively affect our country, but these negative repercussions could be eliminated with more forethought. Merely enacting a law that appears on its face to be content-neutral is not enough. Think! Look ahead at possible consequences. Some legislators have dubbed this tax law the “Job-Killing Tax.”
$716 Billion Slashed from Medicare
Again, on its face, the Medicare reduction in budget does not seem to affect Medicaid recipients. However, sadly, the slash to Medicare will affect those on Medicare, as well as Medicaid. See my blog “Medicaid Expansion: BAD For the Poor” for a more detailed explanation. But basically, Obamacare promised to increase the reimbursement rate to physicians who accept Medicaid patients. In fact, Obamacare raised the reimbursement rate up to the Medicare rate. Concurrently, in order to pay for the costs of Medicaid, Obamacare slashed the Medicare reimbursement rate. Hence, another political sham. A classic smoke and mirrors rendition of making people believe the Medicaid rate would increase, but decreasing the measurement to which the Medicaid reimbursement would equal. Today not enough physicians accept Medicaid. The reason is simple. Physicians are not in the business of free services. If they do not get paid over their own overhead to provide Medicaid services, the easy answer is to refuse Medicaid patients. This causes Medicaid recipients to have little choice of providers and very few choices of providers in specialties.
While this tax is not definitely going into effect in 2013, the talk of this tax going into effect is widespread enough to touch on it. Approximately 1/2 Americans benefit from employer-sponsored health insurance. Mostly, this encompasses American middle class. These are people who make enough to not qualify for Medicaid, but benefit greatly by the employer sponsoring the health insurance. These are not the super wealthy. Yet, this potential new tax would impose a great burden onto middle class America. It is foreseeable that the levy would create such a burden on middle class that many people now benefitting from employer-sponsored private health insurance would no longer be able to pay for the increased costs of health insurance premiums and be forced to turn to Medicaid. This would grow the Medicaid population, causing even more difficulty for Medicaid recipients to find health care professionals accepting Medicaid.
Other Obamacare taxes going into effect in 2013 include:
- Raising the floor for the deduction of medical expenses on income taxes from 7.5% to 10%
- Capping individual contributions to flexible spending amounts from $5000 to $2500.
The above-referenced tax laws will affect the middle class. The middle class, if unable to handle these taxes and changes, will become Medicaid recipients. The growth in Medicaid recipients will cause Medicaid recipients to not be able to find a health care provider. Going back to the sales tax on medical devices, it is possible that physicians will no longer be able to provide Medicaid recipients with needed medical supplies, such as wheelchairs or pacemakers, because of the increased price.
I’ve said it numerous times: The Medicaid system is not equipped to handle the number of recipients that will be thrown at it in the near future. Instead of crippling the system and cause more Americans to rely on Medicaid, we need to fix the Medicaid system. If a Medicaid recipient cannot find a doctor who will accept Medicaid, what is the point of having Medicaid?