Tag Archives: Health Reform

Driving Your Doctor Out Of Business

It began almost as a footnote. 

Five months after Obamacare was passed, members of the Obama administration quietly published an article in The Annals of Internal Medicine describing the law’s planned impact on physicians.  

Shortly thereafter, the piece disappeared and was replaced with a more benign one, with the obvious cooperation of the journal. 

You won’t be able to find the original. It’s been wiped from the internet. 

(And no, not “like with a cloth or something.”)

What was so controversial about the article?

The admission that the law aimed to eliminate private medical practices — and drive physicians into the arms of hospital bureaucrats and huge medical groups. 

From the original:

“The economic forces put in motion by [the ACA] are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups … Physician practices that accept the challenge will be rewarded in the future payment system.”

The article’s authors were Nancy-Ann DeParle, JD, Office of Health Reform director, Robert Kocher, MD, formerly from the Obama National Economic Council — and the now rather infamous Ezekiel Emanuel, MD, Obamacare architect and a really special kind of bad guy.

What’s “vertical organization?”

In Medscape Medical News coverage of the piece, the writer likened “vertical organization” to the military and the federal government.

“This business catchphrase refers to enterprises
with a hierarchal structure and centralized management.
An integrated delivery system that owns hospitals,
medical practices, and other healthcare services is a prime example.”

Wow. Sure sounds like single payer, doesn’t it?

And the Obamacare masterminds have been largely successful in moving the medical community in this direction. Journalist Keith Speight observed in 2013 that:

“While the shift away from private practices was already under way prior to Obamacare, the legislation definitely threw gasoline on the fire.”

In its 2014 survey, the Physician’s Foundation found that “only 35% of physicians describe themselves as independent practice owners, down from 49% in 2012 and 62% in 2008.” In contrast, 53 percent of the survey respondents described themselves as hospital or medical group employees, increasing from 38 percent in 2008 and 44 percent in 2012.

Many of the physicians remaining in small practices have already been heroically laboring to comply with ACA and other federal requirements, spending evenings and weekends transmitting patient data through expensive electronic health record systems. 

The newest iteration of health reform,
MACRA (the Medicare Access and CHIP Reauthorization Act),
will break their backs.

MACRA (previously covered here) restructures physician pay by rewarding more patient data-gathering and obedience to government-dictated clinical and electronic activities.

The Centers for Medicare & Medicaid Services, the agency fleshing out the MACRA regulations, admits that its new rules will penalize 87 percent of solo practitioners  and 69.9 percent of practices with 2 to 9 doctors. Over time, many small practices will lose up to nine percent of their Medicare reimbursements. Meanwhile, only 18.7 percent of clinicians in groups of 100 or more will be penalized.

Tom LaGrelius, MD, president of the American College of Private Physicians, explains that “small organizations cannot possibly comply” with MACRA’s complex data-reporting requirements and will be unable to absorb the MACRA penalties. “Such practices are already running on very narrow margins with 70 percent-plus overheads.” 

The Physician’s Foundation reported that even pre-MACRA Medicare reimbursement has risen only 3.6 percent since 2001, while overhead expenses “have increased well over 20 percent.”

Orthopedic surgeon Tony Francis believes “compliance will be difficult or impossible” for small groups.

“Just reading a 962-page proposed rule would be daunting enough.
Comprehending the meaning of it is something else.
That would take a full team of lawyers and CPAs.
What small practice has that kind of resources?”

Why force independent physicians into hospital jobs? Physician and health policy expert Scott Gottlieb explains:

“It will be easier for Medicare to gain
more direct leverage over their clinical decisions.”

And you know what that means.

RATIONING

The inevitable results of the proposed MACRA regulations are these:

  • We can expect an increase in the “silent exodus” of physicians from clinical care, either through retirement or career change. Even health IT whiz John Halamka, MD, finds the MACRA proposals to be “so overwhelmingly complex that no mere human will be able to understand them… as a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.
  • Some will no doubt surrender their positions as “the knuckle-draggers who just won’t get with the Managed Care 2.0 program,” and join corporate medicine, a move that didn’t turn out well in the 1990’s, and will certainly devalue the medical care Americans have enjoyed in the past. 
  • Others will decide to opt out of the Medicare program and treat Medicare patients through private contracts.
  • Wisely realizing that private insurance companies (the Aetnas and UnitedHealths of the world) will eventually make these very same data-collection demands, many physicians will terminate all insurance contracts, offering private individually-tailored care only through direct-pay or concierge arrangements.

If the MACRA regulations are finalized, not only will independent practices suffer, but so will Medicare beneficiaries. Small physician-owned practices are already known to result in fewer preventable hospital admissions than hospital-owned practices. As the Physicians Foundation points out, while mega-health systems “can handle government rules and regulations,” they simply cannot provide “the personalized care found in the offices of private practices.”

Patients, physicians, and other stakeholders can voice their opinions about the destruction of our physicians’ small businesses at http://bit.ly/macracomment.

Your opportunity to comment will close on June 27, 2016.

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Meet Jeffrey Young, HuffPo’s Medicare Donut Hole

On April 17, Huffington Post’s Jeffrey Young admitted he doesn’t know squat about Obamacare. 

Referring to a Bloomberg article on Obamacare polling, he asked his Twitter followers to enlighten him as to one woman’s claims.

And then he revealed that he has no idea whatsoever as to Obamacare’s impact on Medicare.

“Eventually” deducing that she’s “almost certainly on Medicare,” not Obamacare, he writes off her report as nonsense.

Why, it’s as if Medicare and Obamacare are two distinct and unrelated programs! 

His reasoning? On the one hand, some poor schlubs lost their plans and had to sign up for lousy coverage in the exchanges. On the other, there’s Medicare, the insurance plan for the elderly and disabled. And never the twain shall meet, right?

WRONG, Mr. Young.  And Ms. Stone isn’t a befuddled octogenarian who doesn’t know the difference. 

Ms. Stone was treated at physicians’ offices through Russell Medical Center, which has partnered with the University of Alabama at Birmingham Health System (UAB) since August, 2012. At the time, RMC agreed to a plan of “working together to solve problems in health care delivery.”  In September, 2013, UAB embraced Obamacare’s ambition to reduce health care costs.

Ms. Stone has never had heart problems, but during a routine blood draw, her triglycerides tested at 600, almost 10 times her usual result. Her internist put her on multiple medications and referred her to one of RMC’s cardiologists. 

She then became a cardiac patient. 

With three master’s degrees and two specialty degrees, including one in psychometry, Ms. Stone was no fool. “I knew the lab was wrong.” But she couldn’t convince her doctors to retest her.

“They told me I couldn’t get another test for three months and that I’d need to take all of these medicines in the meantime. They said Obamacare was the reason.”

And they explained how Obamacare is influencing patient care: “The doctors are very dissatisfied, and many of them are not able to give their patients the attention that they feel that they need because they can’t have too many appointments, too many tests.”

The unaware and uninterested Jeffrey Young, HuffPo’s Obamacare expert, admits he’s “puzzled” by this. And this revelation is surprising since he’s written about the donut hole repair, Medicare costs, and the increasing out-of-pocket costs Americans are enduring. He even weighed in on King v. Burwell. One could fairly assume he’s researched the law in its entirety. 

Did he stop reading Obamacare when it came to its reforms of Medicare? Did he get sleepy?

As a national health care reporter, Mr. Young ought to know that no other group is as affected by Obamacare as are seniors on Medicare. The law created a variety of pay-for-performance experiments in Medicare, including the following:

Section 3001: Hospital Value-Based Purchasing Program
Section 3002: Improvements to Medicare’s Physician Quality and Reporting System (PQRS)

Section 3003: Expansion of Medicare’s Physician Feedback Program 
Section 3007: Application of Medicare’s Value-Based Physician Payment Modifier (VBPM) to Physicians Payments 
Section 3022: Medicare’s Shared Savings Program for Accountable Care Organizations
Section 3023: Bundled Payment Pilot 

The goals of these experiments are to reduce costs (in large part by limiting tests and procedures) and to improve the quality of care by “rewarding value” rather than the number of services delivered. 

The problem? Federal government bureaucrats, not health care professionals, are the ones defining quality treatment. And when health care providers don’t attest to their compliance with government-approved standards, they’re penalized.

This is what ophthalmologist and Obamacare rebel Kris Held means when she refers to the law’s perverse incentives that shift focus away from what’s best for the patient to what’s best in the eyes of The System’s cost-cutters.

As physician editor of The Hospitalist Danielle Scheurer cautioned last year, “there is a legitimate concern that physicians will be overwhelmingly motivated to play to the test, so that their efforts to perform exceedingly well at a few metrics will crowd out and hinder their performance on unmeasured metrics. This tendency can result in lower-value care in the sum total, even if the metrics show stellar performance.” 

And lower-value care is just what Dell Stone received, thanks to bureaucratic interference with her treatment. When her triglyceride levels tested alarmingly high, her physician clicked the boxes in his electronic health record and prescribed heart medications, including a potentially dangerous statin drug. And due to the drive to keep testing expenses low, a second lipid panel had to wait.

Thankfully, when Ms. Stone returned to her cardiologist two weeks ago, her three-month wait paid off and she was granted a retest. This time her triglyceride reading was 67.

So, yes, Mr. Young, Obamacare did cause harm to this senior — and is in the process of harming countless others. 

When The System begins experimenting with your grandmother’s care, Mr. Young, will you bother to research Obamacare a bit more?

How Obama Learned To Stop Worrying And Love The Obamacare Bomb

Last fall Duke University research scholar Chris Conover wrote a powerful piece titled “Obamacare’s Three-Legged Stool of Deception,” in which he explained the covert way Obamacare crafters aimed to eliminate job-based health insurance through the Cadillac Tax.

  • The first leg is that the Cadillac tax is paid by insurance companies, when in reality it is paid by employees. 
  • The second leg is that the Cadillac tax is aimed at “lavish” high cost plans, when in reality it is designed to eventually hit virtually every employer health plan (even those with lower-than-average costs). 
  • The third leg is that the Cadillac tax is functionally equivalent to a reform long championed by conservatives: a cap on the tax exclusion for employer-sponsored health insurance. 

Dr. Conover hit a home run in detailing the duplicitousness of the law’s architects, and his piece is probably the best exposé of the Cadillac Tax you’ll find.

But who designed the Cadillac Tax, and how did Obama come to love it?

In his first presidential campaign, Obama repeatedly maintained that he was dead-set against taxation of health insurance benefits. He even chastened his opponent, Senator McCain, for proposing that Americans receive tax credits instead of tax-free insurance benefits.

“This is your plan, John: for the first time in history,
you will be taxing people’s health care benefits.”

Ezekiel Emanuel, special advisor for health policy during the law’s creation, gives us important insights into how, in the summer of 2009, Obama decided campaign promises weren’t as important as was more money in the federal coffers.

Zeke describes a “hot Friday July afternoon” in the White House when he says the “core health team” was working on Obamacare. After about an hour, he recalls, the president walked in, “in his shirt sleeves with his cuffs rolled up. He was there to give us a sort of uplift.” After pleasantries were exchanged,

“I raised with the President one of the issues that had been burning up the staff — the issue of something called the Tax Exclusion.”

In both videos linked above, Zeke describes the issues he and others had with tax-free employee benefits: 

“The big argument we were having was, people on what was called the economic part of the health team…we wanted to do something about the tax exclusion because it’s inflationary, it’s regressive, it’s a lot of money.”

One obstacle? Obama wasn’t clear on his stance: 

“We got into some weeds, and he would say, ‘What did we say about that? What was my position on that? ‘Cos the people should know I stand by my position.’” 

And since David Axelrod, his senior advisor, pointed out that he’d spent $100 million running ads against McCain’s position, the Campaigner-in-Chief stalled, worried that he’d be contradicting his promises.

“David Axelrod, as part of this debate internally, created a montage of all the ads that President Obama had run against John McCain attacking McCain’s proposal — which was basically to get rid of the tax exclusion and give people a tax credit instead to buy health insurance.”

Eventually the economic team won Obama’s heart by showing him how much power and money ($250 billion per year) the Cadillac Tax would grant him.

“I said, you know, Mr. President, as President, you can control a lot related to the public provision of health care insurance — Medicare, Medicaid, CHIP, veterans health benefits — but you don’t have a lot of power over the private side. And that, after all, is the bigger side. It’s most of the money, covers half the American population.” 

That “hot Friday” was July 17, 2009, when the Washington, D.C., temperature soared to 90.9º.

“(O)ver the course of the next few days, this was Friday, then Monday and Tuesday we had meetings around this, the idea began to hold that we should do something about it, we shouldn’t roll it back, but we should modify it.”

The following Monday and Tuesday were July 20 and July 21, 2009. White House visitor logs show an “Economics Team” indeed met the morning of the 20th. (White House visitor logs also indicate that the beloved Jonathan Gruber was in attendance!)

So why did THIS happen, on Thursday, July 23, 2009, in Shaker Heights, Ohio?

“First of all, in terms of taxing benefits, I said I oppose the taxing of health care benefits that people are already receiving, so that’s not a proposal that I’m supportive of…But what I said and I’ve taken off the table would be the idea that you just described, which would be that you would actually provide — you would eliminate the tax deduction that employers get for providing you with health insurance, because, frankly, a lot of employers then would stop providing health care, and we’d probably see more people lose their health insurance than currently have it.”

Dear President Obama, wasn’t that exactly the goal? That we lose our plans and have to join your lousy exchanges?

It’s very odd that Obama repeatedly characterizes his views using terms like “what I’ve said is,” rather than “what I believe is.” 

But it’s more than disappointing to learn that Obama lied to his Shaker Heights audience — and America — mere days after he fell in love with the bomb that will blow up job-based insurance.

H/T Citizen researcher Kathy in Alabama

John Kerry Is No More Trustworthy Than The Disgraced Jonathan Gruber

In summer of 2009, as Obamacare crafters were assembling their plan to destroy the U.S. health care industry, they faced several problems, and most of them involved financing.

Over twenty years ago, Mrs. Clinton’s health reform plan died when the Congressional Budget Office (CBO) determined it would cost too much. 

Learning from her failure, White House officials knew they had to create a plan the CBO could score as budget-neutral. But where, oh, where, would they find the money to not only subsidize insurance purchases but also fund an “unknowable” number of new agencies, boards, commissions, and task forces? 

It was at that point in late-July that Obama’s economic team advocated that the plan eliminate the tax exemption for job-based insurance. What was later dubbed the Cadillac Tax would result in an estimated federal tax grab of $250 billion per year. 

But, as Jonathan Gruber told a Boston audience, any plan that ended the tax exclusion would have been a political hot potato. “Economists have called for 40 years to get rid of the regressive, inefficient and expensive tax subsidy provided for employer provider health insurance…It turns out politically it’s really hard to get rid of.”

That’s where then-Senator John Kerry became Gruber’s “Massachusetts hero” by introducing a scheme to trick Americans. “No, no,” Gruber quotes Kerry, “we’re not going to tax your health insurance. We’re going to tax those evil insurance companies!” 

 When we all know it’s a tax on people who hold those insurance plans.

An ordinary person responsible for such duplicity might have experienced regret, even shame. But not Kerry, who, like Gruber, aimed to exploit Americans’ “lack of basic economic understanding.”

Less than six months later, Kerry doubled down on his deceit, penning a January 2010 Huffington Post piece explaining his support for the Cadillac Tax.

It will help control future health care costs without — I repeat without — directly taxing employees.

Notice the word “directly?” By this he means the tax on insurance companies will be borne by the worker, but certainly not clearly or directly. It was intended that Americans blame insurance companies and employers for jacking up premiums, deductibles, and copayments. (In fact, Harvard faculty members are already blaming the university for out-of-pocket cost increases.) Later, they hope, we will curse our bosses for eliminating job-based insurance altogether.

The excise tax included in the Senate-passed health care bill will affect only a small portion of the very highest cost health plans.

Not according to the American Health Policy Institute, who projects the tax will “hit 17 percent of all American businesses, and 38 percent of large employers” in 2018. And as Gruber explained, the method establishing the yearly tax threshold means that eventually all plans will be subject to the Cadillac Tax. 

For the small sub-set of plans that are affected, the likely impact will be to increase workers’ wages. MIT economist Jon Gruber recently found that the excise tax included in the Senate bill would lead employers to raise wages by $223 billion between 2010 and 2019. In 2019, wages for those affected by the provision will be higher by about $660 per household. I repeat — raise wages.

Did anyone think to ask Kerry how a tax on insurance companies naturally produces higher pay for America’s workers? That’s a curious connection, isn’t it?

Well, you see, Secretary Kerry conveniently omitted the “Employers-Kill-Your-Health-Plan” factor in his analysis. What he failed to mention is his apparent belief that, as employers shrink insurance benefits or dump employees in Obamacare exchanges, they’ll compensate them with higher wages. 

(By the way, this is an assumption based on Gruber modeling, the same model predicting that our health insurance premiums would fall under Obamacare.) 

Finally,

After spending years and years hearing from workers tired of seeing their unions forced to spend all of their energy at the bargaining table just to hold on to health care instead of negotiating for better wages, we now have a way to help increase wages and improve health care simultaneously.

If Kerry believed union workers would gleefully skip off to the Obamacare exchanges, he was wildly uninformed.

Let’s not forget: this is the same John Kerry currently negotiating a nuclear agreement with Iran. 

More than likely, Iran’s mullahs will fare better than Americans have with Obamacare. 

But they may have to sign the deal to find out what’s in the deal.

Jonathan Gruber Cutely Likens Obamacare Victims to Those “Falling Off A Building”

When the “Gruber-gate” story broke last fall, TIME’s Kate Pickert explained that the scandal represented no more than a “flash of candor.” 

Both sides lied, she said. 

Supporters of the law did, in fact, do their best to obscure unpopular provisions—like new taxes. But Republican opponents were just as deceptive in their efforts to exaggerate the law’s potential negative effects.

Journalists, she claimed, “focused more on the politics of the bill than its policies,” and therefore didn’t explain Obamacare well enough. 

And that’s why Americans weren’t aware that the law aimed — through the Cadillac tax — to eliminate 156 million workers’ job-based health insurance.

Pickert summarized a few secrets Obamacare architect Jonathan Gruber shared in his now-controversial speeches:

  • In one video, Gruber says that if the public had really understood that the law would require healthy people to pay for sick people, it wouldn’t have passed. 
  • He also says that the penalty for eschewing health insurance is a “tax,” though Democrats avoided that word because it would have made the law politically unfeasible. 
  • In another video, Gruber explains that a new ACA tax on high-cost health plans supposedly levied on insurers would actually be passed through to consumers.

Pickert confesses that she knew the inner workings of Obamacare, since Gruber had talked with her “many times over the past six years.” 

In one conversation she found worthy of sharing, Gruber reportedly described the Cadillac tax with an analogy reminiscent of the fate of 9/11 victims in the Twin Towers:

In pitching the ACA, Democrats had been adamant that the law would support and sustain the employer-based system, not erode it. But Gruber knew better and he told me so, likening workers being kicked off job-based health plans to people “falling off a building,” an outcome that architects of the ACA knew was likely and had planned for.

People falling off a building. 

Isn’t that adorable?

Ms. Pickert apparently believes Gruber’s openness with his private audiences is refreshing. She fails to address why the American public wasn’t privy to Gruber’s secrets.

But, you see, if America had known Obamacare would kill job-based coverage, Obama would have lost his bid for reelection.

And in the world of Kate Pickert and her ilk, that would have been a far worse outcome than falling off a building.

At Least Eighty-Eight Democrats Lied to You About Obamacare

President Obama wasn’t the only politician to qualify for Politifact’s “2013 Lie of The Year.” Many members of Congress also assured their constituents that Obamacare would leave health insurance plans intact.

Now we know that “the vast majority” of Americans would lose their 2010 health insurance coverage and that the Cadillac tax will eliminate employer-sponsored insurance for many in coming years. Since another wave of cancellations is occurring, it’s worthwhile to expose the Congress members who caused this harm.

In late-2013, when millions learned their policies were being canceled, Senator Mitch McConnell’s office compiled a list of 27 senators who’d pledged that Americans could keep their coverage.

Sen. Harry Reid (D-NV): “In fact, one of our core principles is that if you like the health care you have, you can keep it.” (Sen. Reid, Congressional Record, S.8642, 8/3/09)

Sen. Richard Durbin (D-IL): “We believe — and we stand by this — if you like your current health insurance plan, you will be able to keep it, plain and simple, straightforward.” (Sen. Durbin, Congressional Record, S.6401, 6/10/09)

Sen. Chuck Schumer (D-NY): “If you like your insurance, you keep it.” (U.S. Senate, Finance Committee, Bill Mark-Up, 9/29/09)

Sen. Patty Murray (D-WA): “Again, if you like what you have, you will be able to keep it. Let me say this again: If you like what you have, when our legislation is passed and signed by the President, you will be able to keep it.” (Sen. Murray, Congressional Record, S.6400, 6/10/09)

Sen. Max Baucus (D-MT): “That is why one of the central promises of health care reform has been and is: If you like what you have, you can keep it. That is critically important. If a person has a plan, and he or she likes it, he or she can keep it.” (Sen. Baucus, Congressional Record, S.7676, 9/29/10)

Sen. Tom Harkin (D-IA): “One of the things we put in the health care bill when we designed it was the protection for consumers to keep the plan they have if they like it; thus, the term ‘grandfathered plans.’ If you have a plan you like — existing policies — you can keep them. … we said, if you like a plan, you get to keep it, and you can grandfather it in.” (Sen. Harkin, Congressional Record, S.7675-6, 9/29/10)

Sen. Tammy Baldwin (D-WI): “Under the bill, if you like the insurance you have now, you may keep it and it will improve.” (Rep. Baldwin, Press Release, 3/18/10)

Sen. Mark Begich (D-AK): “If you got a doctor now, you got a medical professional you want, you get to keep that. If you have an insurance program or a health care policy you want of ideas, make sure you keep it. That you can keep who you want.” (Sen. Begich, Townhall Event, 7/27/09)

Sen. Michael Bennet (D-CO.): “We should begin with a basic principle: if you have coverage and you like it, you can keep it. If you have your doctor, and you like him or her, you should be able to keep them as well. We will not take that choice away from you.” (Sen. Bennet, Press Release, 6/11/09)

Sen. Barbara Boxer (D-Calif.): “So we want people to be able to keep the health care they have. And the answer to that is choice of plans. And in the exchange, we’re going to have lots of different plans, and people will be able to keep the health care coverage they need and they want.” (Sen. Boxer, Press Release, 2/8/11)

Sen. Sherrod Brown (D-OH): “Our bill says if you have health insurance and you like it, you can keep it…” (Sen. Brown, Congressional Record, S.12612, 12/7/09)

Sen. Ben Cardin (D-MD): “For the people of Maryland, this bill will provide a rational way in which they can maintain their existing coverage…” (Sen. Cardin, Congressional Record, S.13798, 12/23/09)

Sen. Bob Casey (D-PA): “ If you like what you have, you like the plan you have, you can keep it. It is not going to change.” (Sen. Casey, Congressional Record, S.8070, 7/24/09)

Sen. Kay Hagan (D-NC): “People who have insurance they’re happy with can keep it. We need to support the private insurance industry so that people who have insurance they’re happy with can keep it while also providing a backstop option for people without access to affordable coverage.” (“Republicans Vent As Other Compromise Plans Get Aired,” National Journal’s Congress Daily, 6/18/09)

Sen. Mary Landrieu (D-LA): “If you like the insurance that you have, you’ll be able to keep it.” (MSNBC’s Hardball, 12/16/09)

Sen. Pat Leahy (D-VT): “[I]f you like the insurance you now have, keep the insurance you have.” (CNN’s “Newsroom,” 10/22/09)

Sen. Bob Menendez (D-NJ): “If you like what you have, you get to keep it” “Menendez is a member of the Senate Finance Committee, which is expected to release a bill later this week. He stressed that consumers who are satisfied with their plans won’t have to change. ‘If you like what you have, you get to keep it,’ he said.” (“Health Care Plan Would Help N.J., Menendez Says,” The Record, 6/19/09)

Sen. Jeff Merkley (D-OR): “[E]nsuring that those who like their insurance get to keep it” “The HELP Committee bill sets forward a historic plan that will, for the first time in American history, give every American access to affordable health coverage, reduce costs, and increase choice, while ensuring that those who like their insurance get to keep it.” (Sen. Merkley, Press Release, 7/15/09)

Sen. Barbara Mikulski (D-MD): “It means that if you like the insurance you have now, you can keep it.” (Sen. Mikulski, Press Release, 12/24/09)

Sen. Jay Rockefeller (D-WV): “I want people to know, the President’s promise that if you like the coverage you have today you can keep it is a pledge we intend to keep.” (U.S. Senate, Finance Committee, Hearing, 9/23/09)

Sen. Jack Reed (D-RI): “If you like the insurance you have, you can choose to keep it.” (Sen. Reed, Town Hall Event, 6/25/09)

Sen. Bernie Sanders (I-VT): “‘If you have coverage you like, you can keep it,’ says Sen. Sanders.” (“Sick And Wrong,” Rolling Stone, 4/5/10)

Sen. Jeanne Shaheen (D-NH): ‘if you have health coverage that you like, you get to keep it’ “My understanding … is that … if you have health coverage that you like you can keep it. As I said, you may have missed my remarks at the beginning of the call, but one of the things I that I said as a requirement that I have for supporting a bill is that if you have health coverage that you like you should be able to keep that. …under every scenario that I’ve seen, if you have health coverage that you like, you get to keep it.” (Sen. Shaheen, “Health Care Questions From Across New Hampshire,” Accessed 11/13/13)

Sen. Debbie Stabenow (D-MI): “As someone who has a large number of large employers in my state, one of the things I appreciate about the chairman’s mark is — is the grandfathering provisions, the fact that the people in my state, 60 percent of whom have insurance, are going to be able to keep it. And Mr. Chairman, I appreciate that. That’s a strong commitment. It’s clear in the bill…if you have your insurance you can keep it. That’s the bottom line for me.” (U.S. Senate, Finance Committee, Bill Mark-Up, 9/24/09)

Sen. Jon Tester (D-MT): “‘If you like your coverage, you’ll be able to keep it,’ Tester said, adding that if Medicare changes, it will only become stronger”. (“Tester In Baker To Discuss Health Care,” The Fallon County Times, 11/20/09)

Sen. Tom Udall (D-NM): “Some worried reform would alter their current coverage. It won’t. If you like your current plan, you can keep it.” (“What I Learned: About Health Care Reform This Summer, By Your Lawmakers In Congress,” Albuquerque Journal, 9/8/09)

Sen. Sheldon Whitehouse (D-RI): “…it honors President Obama’s programs and the promise of all of the Presidential candidates that if you like the plan you have, you get to keep it. You are not forced out of anything.”(Sen. Whitehouse, Congressional Record, S.8668, 8/3/09)

And the senators weren’t alone. At least 60 House members misled their constituents as well.

Rep. G.K. Butterfield (D-NC): “For North Carolinians who already have health insurance, the only changes you will see under the Affordable Care Act are new benefits, better protections from insurance company abuses, and more value for every dollar you spend on health care. If you like your plan you can keep it, and you don’t have to change a thing due to the health care law.” (“Health Care Resources,” as seen on 10/24/2013)

Rep. Tony Cárdenas (D-CA): “If you have insurance right now, your plan stays the same. This means if you get your health insurance through work, if you have Medicare or if you are a member of California Healthy Families, you keep that coverage.” (“What Valley Residents Need to Know about Health Care Reform”)

Rep. Kathy Castor (D-FL): “…If you like your health insurance, you can keep it. Keep your current doctor as you see fit.” (“What Does Health Insurance Reform Mean for You?”) “Nothing in this bill will force you to drop your current coverage. Rest assured, if you like your health insurance, you can keep it.” (Press Release, 7/31/2009)

Rep. Yvette Clarke (D-NY): “IF YOU HAVE HEALTH INSURANCE…You can keep your doctor and your plan.” (“What Health Care Reform Means for You”)

Rep. William Clay (D-MO): “Under the legislation, individuals and families with employer-based coverage can keep the health insurance coverage they have now, and it will get better.” (Congressman Clay’s Capitol Hill Report, 11/10/09)

Rep. Emanuel Cleaver (D-MO): “I am committed to a health care plan that covers every single American, reduces the cost of care, allows people to keep their insurance if they like” (Press Release, 8/20/2009)

Rep. Gerry Connolly (D-VA): “I already have insurance through an employer, a union, Medicare, Medicaid, TriCare, the VA, COBRA, or a retirement plan. Do I need to do anything? No. If you have coverage from any of these sources, you can keep it. Nothing in the Affordable Care Act requires you to change plans.” (Obamacare FAQ)

Rep. John Conyers (D-MI): “Your premiums and other costs will not increase as a result of health care reform and if you like the coverage you have now, you’ll be able to keep it. In fact, you’ll get some additional help paying for premiums and out-of-pocket costs.” (“How Will Obamacare Affect Me?” Questionnaire)

Rep. Jim Costa (D-CA): “I currently have an insurance plan that works. How will the new health care law affect me? Health reform protects existing coverage, and encourages employers to maintain it. It also improves current coverage by strengthening consumer protections.” (Obamacare FAQ)

Rep. Joseph Crowley (D-NY): “Our health care plan provides stability and security for those who have health insurance.  If you like what you have, you can keep it.” (Press Release, 11/7/2009)

Rep. Henry Cuellar (D-T): “Keep your doctor, and your current plan, if you like them.” (Health Care Reform Summary, prepared by House Democratic Leadership, 8/10/2009)

Rep. Danny Davis (D-IL): “It protects current coverage allowing individuals to keep the insurance they have if they like it and preserves choice of doctors, hospitals, and health plans. It achieves these reforms through…” (Health Care Reform Summary)

Rep. Peter DeFazio (D-OR): “The legislation is not a government takeover of health care. It will not get between anyone and their doctor. If you have insurance, you can keep your current plan.” (Press Release, 3/24/2010)

Rep. Diane DeGette (D-CO): Not a quote attributed to her, but part of a news article she posted on her website: “Mr. Obama has said repeatedly, as he told the American Medical Association in June: “If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.” These assurances reflect an aspiration, but may not be literally true or enforceable.” (In the News, 8/10/2009)

Rep. Ted Deutch (D-FL): “If you have job-based health insurance you like, you can keep it.” (Health Care FAQ)

Rep. Lloyd Doggett (D-TX): “If you already have coverage through your employer, Medicare, TRICARE, or some other source, you can keep that insurance and you are not required to buy additional coverage.” (The Affordable Care Act)

Rep. Keith Ellison (D-Minn): “If you like the insurance you have, you can keep it. Don’t listen to that stuff you heard in the last hour, Mr. Speaker. The truth is, you get to keep your health insurance if that’s what you want.” (Floor Speech)

Rep. Eliot Engel (D-NY): “This is a great day for all Americans from all walks of life – seniors, youth, the sick and the healthy. If you have health insurance, you can keep your doctor and your health plan. You like it, you keep it. It’s that simple.” (Press Release, 11/9/2009)

Rep. Anna Eshoo (D-CA): “Q. My employer already provides coverage for me and my family and I like my plan. Do I need to do anything differently? A. No. You just keep the coverage you have.” (Press Release, as seen on 10/22/2013)

Rep. Sam Farr (D-CA): “If you have job-based health insurance you like, you can keep it. You’re considered covered. You may be able to change to Marketplace coverage if you prefer.” (Obamacare FAQ)

Rep. Chakah Fattah (D-PA): ““This plan means that those who are satisfied with their current coverage and doctor can keep their plan and their physician.  However, if they aren’t happy with their coverage then this plan will help them find and afford quality healthcare.” (Press Release, 7/14/2009)

Rep. John Garamendi (D-CA): “Just six months after our historic health insurance reforms were signed into law, important consumer protections are going into effect.  These protections mean that never again will your insurance run out or be taken away from you when you need it the most.” (Press Release, 10/20/2010)

Rep. Gene Green (D-T): “If you have job-based health insurance you like, you can keep it. In fact, with new regulations and standards, the insurance you currently have will include new consumer protections like no lifetime limits, minimum coverage standards, and limits on administrative costs.” (Obamacare FAQ)

Rep. Raul Grijalva (D-AZ): “No one is forced to do anything. The entire premise of this legislation is to build on what works in today’s system. If you have employer sponsored health care today – as do most insured people – than little to nothing will change, except that your premiums will no longer subsidize coverage for the uninsured. If you are covered in the individual insurance market, you can keep your plan permanently and it will count as acceptable coverage even if it doesn’t meet those terms under the new law.” (Obamacare FAQ)

Rep. Alcee Hastings (D-FL): “Individuals who already have health insurance through their employers or are self-insured will keep their insurance. There is absolutely no provision within the ACA that would remove existing coverage from individuals and families. Furthermore, the law will make existing plans more secure and affordable.” (Obamacare FAQ)

Rep. Mike Honda (D-CA): “Under the bill, if you are covered by a large employer, you are not likely to see many changes to your healthcare coverage.” (Blog Release, 4/5/2010)

Rep. Steny Hoyer (D-MD): “We need to build upon the current system of employer-sponsored care, with a system that provides patients their choice of insurance coverage and their choice of doctors. In other words, if you like what you have, you should be able to keep it.” (Town Hall Meeting, 4/21/2009)

Rep. Hakeem Jeffries (D-NY): “But I’m happy with my health care.  What does this change for me? Nothing. You can keep the plan you have.” (Obamacare FAQ)

Rep. Hank Johnson (D-GA): “It is important to note that nothing will change for those who are happy with the insurance they already have from their employer, seniors on Medicare, TRICARE or people on Medicaid.” (E-Newsletter, 7/24/2013)

Rep. Eddie Bernice Johnson (D-TX): “If you have health insurance you like, I want you to be able to keep it,” she continued.” (Telephone Townhall, 5/6/2009)

Rep. Marcy Kaptur (D-OH): “The goal is to try to get you into a plan that you pick, where you feel you have very carefully monitored care, that you participate in, so nobody’s left out, nobody’s rejected and you have choices. That sounds like a much better system than we have today for so many people. If you like what you have, you keep it…” (Press Release) “The whole intention of the law is to relieve some of the worries that seniors face,” Congresswoman Kaptur said.  And, “you keep the insurance that you have if you like it.” (Telephone Townhall)

Rep. Joseph Kennedy (D-MA): “If you have job-based health insurance you like, it is not necessary to change your plan. You may be able to change to Marketplace coverage if you prefer. Any job-based health plan you currently have qualifies as minimum essential coverage.” (Obamacare FAQ)

Rep. Ron Kind (D-WI): “In order to increase access to affordable coverage we must make sure no one is denied coverage, specifically due to pre-existing conditions.  Reform seeks to build on the existing system so that if you like your employer sponsored health insurance, you can keep it.” (Press Release, 7/22/2009)

Rep. Jim Langevin (D-RI): “Keep your doctor, and your current plan, if you like them.” (Newsletter, 8/10/2009)

Rep. Rick Larsen (WA): “This bill will give the power back to the American consumer. It preserves choice and creates competition in the insurance market. If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor.” (Press Release, 3/21/2010)

Rep. John Larson (CT) “I am committed to health care reform that allows you to keep your current plan if you like it, reform that puts you and your doctor in charge of your care.” (Press Release, 8/24/2009)

Rep. Sandy Levin (D-MI): “If you like your current health plan, you will be able to keep it.  But it is clear that our nation wants us to fix what’s not working by reducing costs, increasing prevention, improving quality, and covering uninsured Americans,” said Rep. Levin.” (Press Release, 6/9/2009)

Rep. John Lewis (D-GA): “This bill does not replace employer-sponsored coverage, it actually adds to the choices people have. If people like their insurance, they can keep it.” (E-Newsletter, 10/10/2009)

Rep. Michelle Lujan Grisham (D-NM): “If you are already receiving coverage through eligible employer-sponsored insurance, eligible individual insurance, grandfathered health plans, and federal programs such as Medicare, Medicaid, VA Health Care, CHIP and others, you do not need to purchase new health insurance.” (Blog Post, 11/6/2013)

Rep. Doris Matsui (D-CA): “If you are insured and already have a ‘qualified’ health insurance plan through your employer, nothing changes.  You can keep your plan.  You can keep your doctor.” (Obamacare FAQ)

Rep. Jerry McNerney (D-CA): “Reforming health care is a fiscally responsible course of action that will build on the best of the American system by making sure people can keep their current insurance if they like it and choose what doctors they want see.” (Press Release, 3/22/2010)

Rep. Miller, George (D-CA): “If you get insurance through your job or have Medicare, you don’t need to do anything — you can keep your insurance.” (Blog Post, 9/30/2013)

Rep. Rick Nolan (D-MINN): “If you like the plan you have, you can keep it.” (ACA Resources)

Rep. Frank Palone  (D-NJ): “Our health plan fulfills commitments made by this Congress and President Obama to reform health care. The plan…Keeping your doctor and your plan if you like them.” (Press Release, 7/19/2009)

Rep. Mark Pocan (D-WI): I have health insurance from my employer, and I like the plan that I have. Do I get to keep it? “You can keep the plan you have.” (ACA FAQ)

Rep. Jared Polis (D-CO): “If you are currently insured and like the plan you have, you’ll likely be able to stick with your current plan.” (“Obamacare Enrollment Begins Today,” 10/1/2013)

Rep. David Price (NC): “Just as in the past, if you like your doctor, you can choose to stay with your doctor.” (Constituent Mailing, 7/14/2013)

Rep. Mike Quigley (D-IL): “Allows you to keep your coverage and doctor if you like them.” (Press Release, 8/20/2009)

Rep. Charles Rangel (D-NY): “This plan tells every American – if you have coverage and a doctor you like, keep it…If you like your doctor and current plan you can keep them” (Press Release, 7/15/2009)

Rep. John Sarbanes (D-MD): “Keep your doctor, and your current plan, if you like them…If you like your doctor and your current plan, you can absolutely keep them” (Health Care Reform E-Newsletter, 8/12/2009)

Rep. Allyson Schwartz (D-PA): “If you already have health coverage you like, you can keep it.” (ACA: Update)

Rep. Albio Sires (D-NJ): “If people like their current plans, they will be able to keep them.” (Mailing)

Rep. Eric Swalwell (D-CA): “If you have employer-provided health insurance, public program insurance such as Medicare, or are a veteran receiving VA health care, you are considered covered and can keep your current plan.” (ACA FAQ)

Rep. Niki Tsongas (D-MA): “The legislation takes significant steps towards covering all Americans, while enabling anyone happy with their current plan to keep it.” (Press Release, 3/21/2010)

Rep. Chris Van Hollen (D-MD): “If you like your doctor and your plan, you can keep them.” (Press Release, 7/14/2009)

Rep. Debbie Wasserman Schultz (D-FL): “Let me be clear: if you like your current plan, you’ll be able to keep it. Rather, we will build on our current system, so we can give you the freedom to choose what works best for you and your family. If you like your doctor, keep your doctor. If you like your current plan, keep your current plan.” (Press Release, 7/1/2009)

Rep. Mel Watt (D-NC): “Under the ACA, those who already have health insurance coverage under the following plans will continue to enjoy their coverage without interruption and without taking any action: Employer-sponsored plans.” (Obamacare FAQ)

Rep. Henry Waxman (D-CA): “If you like your doctor and your current plan, you keep them.” (Press Release, 3/21/2010)

Rep. Peter Welch (VT): “Under the legislation, individuals with insurance can keep the coverage they have now, and it will get better.” (Obamacare FAQ)

Rep. John Yarmuth (D-KY): “Keep your doctor, and your current plan, if you like them.” (Obamacare FAQ)

If Americans had been told the truth about Obamacare’s impact on their health insurance, would President Obama have been re-elected?

UPDATE, 3.18.15: 

Seven additional lying liars have been located. That brings us to at least 95 Congress members who deceived Americans about Obamacare.

Rep. Bruce Braley (D-IA): “If you’re covered and you like your insurance, you can keep it.”

Sen. Gary Peters (D-MI): ObamaCare would “allow Americans to maintain their choice of health insurance.”

Sen. Mark Pryor (D-AK): ObamaCare would “protect and expand an individual’s choice of doctors and insurance plans.”

Sen. Chris Coons (D-DE):  “If you have job-based health insurance you like, you can keep it.”

Sen. Brian Schatz (D-HI): “If you like your health care coverage, you can keep it.”

Sen. Ed Markey (D-MA): “Under our proposal, if you like your current health-care plan, you can keep it.”

Sen. Mark Warner (D-VA): “I’m not going to support a healthcare reform plan that’s going to take away the healthcare you’ve got right now or a healthcare plan that you like.”

Ninety-five members of Congress. Wow. At this point, it may be easier to catalogue those who didn’t lie to you than those who did.

Research on Past Health Reform Efforts Yields a Slam-Dunk for King v. Burwell Plaintiffs

The stakes are awfully high in the SCOTUS King v. Burwell ruling, to be announced later this spring.

If the Supreme Court decides the administration illegally extended Obamacare subsidies to those enrolled through Healthcare.gov, many Americans will lose the financial aid they were promised and find health insurance coverage unaffordable.

[By the way, this begs a few questions: Why is the government mandating that Americans buy individual policies that are, on average, 49% more expensive than they were pre-Obamacare — after scheming to throw millions of Americans off their old policies? Aided by the over 500,000 health insurance agents in the country, aren’t we capable of finding insurance that meets our particular needs? Or are we just too stupid to know what’s good for us?]

On the other hand, a ruling for the plaintiffs would release 57 million Americans from mandates to which the law, as written, did not subject them. Employers in most states could relax about the law’s potentially huge blow to their financial health, countless Americans would no longer fret about dealing with IRS employees tasked to oversee their premium payments, and state economies could improve.

A most stunning and disappointing episode in U.S. politics is revealing itself, as Congressional Democrats are now forced to admit they didn’t read the fundamentally transformative bill for which they voted in 2009 and 2010. Pro-government amicus briefs assert that Congress never intended — or worse yet, understood — that premium subsidies were restricted to state-established exchanges, despite the law’s clear language.

It’s as if they’re saying, “Never mind what we voted for! What’s important is what we thought we were voting for!”

Would that work with your mortgage? Would a bank allow you to unilaterally change the terms of your home loan because you didn’t read — or understand — the contract you signed? That’s the federal government’s position here.

And are Congressional Democrats telling us the truth about their intentions in 2009 and 2010? Remember: these are the very same people who repeatedly assured us we could keep our plans and our doctors.

The administration maintains that it’s well within its bounds to rewrite Obamacare. It also says it would have been “perverse” for Congress to pressure states to cooperate with the sweeping law by holding premium subsidies over their heads.

Thanks to a great deal of health reform research, we know this kind of perversity has endured through over four decades of proposals, from Nixon, through Clinton, and through subsequent plans.

This Forbes analysis gives the details, but here’s the takeaway: Given the history of U.S. health reform efforts, it’s looking likely the King plaintiffs are correct in claiming Obamacare drafters aimed to punish refusenik states. In fact, after digesting this research, we may legitimately ask, why wouldn’t they?