© David Burton 2015

     On 23 March 2015, Obamacare turned 5 years old. Numerous promises and claims in support of Obamacare were made to the American people during and susequent to candidate Obama's 2008 presidential camaign in order to gain support for the proposed law. The major argument made in favor of Obamacare was that it provided affordable health care to all Americans. Nobody really objected to the achievement of that goal. Some five years later, the original objection was (and still is) that Obamacare is quite simply a monstrosity of poor legislation! The objective was admirable – the implementation however has proven to be a total abomination.

     So what has become of all the promises made to the American people starting some seven years ago, with President Obama’s first presidential campaign?

     When President Obama signed into law the piece of legislation which is now most commonly known as “Obamacare”, he and his Obamacare supporters promised many things,including lower health care costs, universal coverage, and high quality care. Five years later, with the exception that the number of uninsured is dropping, the health law has largely failed to fulfill those grandiose promises. It has become increasingly clear that most of the numerous promises made to the American people were mere rhetoric.

     In the futile struggle to fix or tweak the weaknesses and failures of Obamacare, the law’s originators and its supporters are proposing to strengthen the government’s hand in managing and regulating this fatally flawed and ill-conceived piece of legislation. Sticking a finger in the hole in the dike won’t stop the eventual collapse of the dam.

     The need for health care reform has never been questioned by either proponents or opponents of Obamacare. Controlling costs, improving quality, and expanding access are shared objectives. Yet, while both sides agree that reform is necessary, their solutions differ dramatically, especially with respect to the question of who ultimately controls the major health care decisions. The creators and proponents of Obamacare believe that the government should be the key decision maker and consequently that health care decisions should be imposed through detailed federal rules and regulations. The broken promises of the President provide an excellent example of the consequences of such an approach.

     The objective of Obamacare may have been admirable, but the health care law that was railroaded into law five years ago was ill-conceived, convoluted, and is proving to be disastrous to many health care recipients. In many respects, the promises made were outright fabrications meant to obtain support for the law and to hide its many shortcomings. In fact, President Barack Obama and his administration misled the American public on Obamacare because of their belief in "the stupidity of the American voter". (Ref. 1)

The Nuts and Bolts

     Is Obamacare working? Some – maybe many – would say, not very well. Consider the plight of some Massachusetts residents struggling - largely in vain - to arrange for their health care under the state’s mandated health care program. “A new wave of maddening problems has hit the state’s ever-embattled Obamacare agency, as enraged customers complain of triple charges, abrupt termination notices and hourlong waits to speak to unhelpful support reps.
     “{One irate customer reported that} he’s facing an $11,000 medical bill from an eye surgery . . . after the Connector retroactively canceled his insurance. . . . He . . . learned his {insurance} payment didn’t go through but was never notified of the failure or that his insurance was canceled until after the surgery. . . . {He} received no email, no telephone call, no piece of mail … indicating any kind of a problem.
      - - -
     “Frustrated customers have slammed the {Health Care} Connector’s Facebook page with complaints and problems . . . lamenting abruptly canceled health plans and long customer hold times.” (Ref. 2)

     President Obama’s has made numerous promises about Obamacare’s effect on everyday Americans. Five years into its implementation, it is growing ever more apparent that these promises were, at best, fantasies.

Cost

     Obamacare was supposed to reduce the cost of health care. As one personal example of Obamacare’s failure to do this, consider the following. Toward the end of 2014, my wife and I received notices that our Social Security benefits were going to increase by 1.7% in 2015 because of a rise in the cost of living. Halleluiah! But wait a minute! The total amount of social security benefits we would be receiving for 2015 was $1,440 less than we received in 2014! How could that be? Simple – the government raised our Medicare premiums which more than wiped out our increase in Social Security benefits. One more verification of the old sayings: “Never believe what a politician says”, and “Figures don’t lie but liars can figure”.

     If he were to be elected, “candidate Obama boasted in 2008, ‘we’ll lower premiums by up to $2,500 for a typical family in a year.’
     “Flash forward to 2015. . . . premiums for individual Americans skyrocketed after Obamacare became law. For 23-year-old men, premiums rose by as much as 78 percent. For 63-year-old men, premiums increased 23 percent.
     “The story was much the same for women – with 23-year-olds experiencing spikes of 45 percent, while those 63 years of age saw premiums jump 38 percent.
     “Drug costs have jumped, too, despite promises to the contrary from the Obama administration.
     “On Obamacare’s third birthday, the White House reassured Americans that the health law would protect vulnerable patient populations {by} ‘preventing them from being charged more because of a pre-existing condition or getting fewer benefits like mental health services or prescription drugs’ . . .
     “Instead, drug costs for these patients have skyrocketed. The majority of health plans offered on the exchanges have shifted costs for expensive medications onto patients . . . In 2015, more than 40 percent of all ‘silver’ exchange plans – the most commonly purchased plans – charged patients 30 percent or more for specialty drugs. Only 27 percent of silver plans did so last year.” (Ref. 1)

     “Finally, five years on, President Obama’s declaration that he would not sign a plan that ‘adds one dime to our deficits – either now or in the future’ looks more ridiculous than ever.
     “In 2010, the Congressional Budget Office anticipated Obamacare’s decade-long cost was $940 billion. This year, the CBO more than doubled that price tag, with a new estimate of $2 trillion.
      - - -
     “Time and again, President Obama has been proven wrong about what his health law would accomplish. Quality hasn’t improved and costs continue to grow. That’s Obamacare’s 5-year-old legacy.” [Emphasis mine] (Ref. 3)

     Among the promises made by President Obama, were the following (PPACA stands for Patients Protection and Affordable Care Act and is just another name for Obamacare, designed to make it more appealing to the American public.):

“In an Obama Administration, we’ll lower premiums by up to $2,500 for a typical family per year.”
Reality: “Premiums for those who purchase coverage in the individual market have significantly increased in a majority of states, and premiums in the group market also continue to rise. In 2014, PPACA coverage in the exchanges was more expensive than comparable 2013 coverage in the pre-PPACA individual market in 42 states. For Americans with employer-sponsored coverage, premium costs also continue to increase. Family premiums for employer-sponsored coverage have increased by an average of $3,459 since 2009.
     “Although 2015 premium rates have not been finalized, an initial analysis of 19 states with available data shows that 28 percent of Silver-level exchange plans will have premium increases greater than 10 percent, while only 14 percent of Silver-level exchange plans will have rate decreases of more than 10 percent.”

“Under my plan, no family making less than $250,000 a year will see any form of tax increase.”
Reality: “The PPACA contains 18 separate tax increases, fees, and penalties, many of which heavily impact the middle class. Altogether, the PPACA’s taxes and penalties will collect more than $770 billion in new federal government revenues over 10 years. The individual mandate, the medical device tax, the federal health insurer tax, and new penalties and limits on health savings accounts and flexible spending accounts are just a few of the taxes that affect middle class Americans.” (Ref. 4)

     While President Obama promised that Obama care would not impose any new taxes, there have indeed been new taxes resulting from the passage of the health care law. Some of these taxes are hidden from view. “The third Obamacare tax hike on young adults and kids is on FSAs {Flexible Spending Accounts}. Many young people and parents of young children participate in flex accounts (FSAs) at work. Obamacare imposes a new cap of $2,500 per year on these accounts, which currently face no limits from the tax code. This will, again, fall largely on parents with young children. Consider braces, for example. A parent needing to buy a $4,000 pair of braces might want to run that cost through their flex account to make it pre-tax. A $2,500 cap makes that impossible for the whole cost.

     There were unpleasant surprises in store for some of those who signed up for Obamacare in its second year of enrollment. That's because a number of low-priced Obamacare plans raised their rates in 2015, making those options less affordable. On top of that, penalties for failing to secure a health-insurance plan will rise steeply next year, which could cost some families a large chunk of money. An uninsured family could be fined as much as $975. That penalty would affect lower-income or middle-income households the most. Some middle-class families might be making enough that they don't qualify for a subsidy under Obamacare, so they won't be subsidized for getting health coverage. These middle-class families could incur the large penalty if they choose not to have any health care insurance.[5]

     “It's not only the uninsured who will be facing higher costs. Many health-care plans are also charging more, with Investor's Business Daily finding that a 27-year-old earning 250 percent of the poverty rate will pay an average of 7 percent more for the lowest-cost bronze plan, based on an analysis of rates in the largest city in 34 states. The lowest-cost silver plan will rise an average of 9 percent, while the lowest-priced catastrophic policy will climb 18 percent, the analysis found.” (Ref. 5) Who was it that said costs would not go up under Obamacare?

Unintended Consequences

     “Last year {2014), a study found that about four out of every 10 people who received financial help from the government while buying their Obamacare health plans had no idea they were getting any assistance.
     “This tax season {2015}, many of those people may be in for a rude surprise when they're asked to pay some—or even all—of that money back. (Ref. 6)

     The following is a summary of Reference 6 which reported on the problem created by Obamacare.

     After having his taxes done, a 61 year old retired US Airways flight attendant learned that he had to pay back every cent of the $6,624 in federal subsidies that helped pay the lion's share of his Obamacare plan. These subsidies were given to recipients whose estimated annual income came in between 100% and 400% of the poverty level.

    He was paying $89 per month and the government was paying $736. He only learned about the subsidy and its value when he received a 1095-A form from the IRS this year. He said he wasn't told about the subsidy when he applied for insurance over the HealthCare.gov telephone assistance line.

     He had no idea that if his actual annual income ended up being higher than the $22,000 he had estimated at the time when he applied for the insurance that he would owe at least some of the subsidy back to the federal government.

     And because his income ended up being more than 400%, he owed back the entire amount in aid he had received. He went over the income "cliff" because he withdrew about $30,000 from his 401(k) retirement plan.

     About 50% of subsidized Obamacare customers will owe money back, which will offset their tax refunds or wipe them out altogether.

Choice

     “The president promised in 2013 that ‘this law means more choice, more competition, lower costs for millions of Americans.’ But that hasn’t turned out to be true. . . . {T}he number of insurers selling to individual consumers in the exchange this year is 21.5 percent less than the number that were on the market in 2013 – the year before the law took effect.
     “The Government Accountability Office reports that insurers have left the market in droves. In 2013, 1,232 carriers offered insurance coverage in the individual market. By 2015, that number had shrunk to 310. [Emphasis mine]
     “With competition in the exchanges on the decline, quality is going down too – just like President Obama said, in 2013: ‘without competition, the price of insurance goes up and the quality goes down.’ {At least, he got that part right!}
     “Consumers who purchase insurance on the law’s exchanges have fewer options than they had pre-Obamacare. . . . {R}oughly two-thirds of the hospital networks available on the exchanges were either ‘narrow’ or ‘ultra-narrow.’ That means that these insurance plans have refused to partner with at least 30 percent of the area’s hospitals. Other plans exclude more than 70 percent.
     “Patients may also have fewer doctors to pick from. More than 60 percent of doctors plan to retire earlier than anticipated . . . {N}early half of all doctors – especially those with more experience – considered Obamacare’s reforms a failure.
     “So while more Americans may have insurance thanks to Obamacare, they may not be able to find a doctor to see them. That’s a recipe for waiting lists and de facto rationed care. [Emphasis mine]
     "Two of President Obama’s promises to the American people were:

“If you like your health care plan, you’ll be able to keep your health care plan, period.”
Reality: “Millions of Americans have already lost, and more will likely lose, their coverage due to the PPACA. The PPACA has significantly disrupted the market for those who buy coverage on their own by imposing new coverage and benefit mandates, causing a reported 4.7 million health insurance cancelations in 32 states in 2013.
     “The same is true for those with employer-sponsored insurance. During the first half of 2014, Heritage Foundation analysis of the market enrollment data found that net enrollment in employer-group coverage declined by almost 4 million individuals, offsetting the gains in individual-purchased coverage by 61 percent.”

“If you like your doctor, you will be able to keep your doctor, period.”
Reality: “Many Americans have not been able to keep their doctors as insurers try to offset the added costs of the PPACA by limiting the number of providers in their networks. In many of the PPACA’s exchange plans, access to providers is limited; nationwide, 48 percent of all exchange plan provider networks are deemed to be ‘narrowed’ and of those narrowed networks, nearly 40 percent are classified as ‘ultra-narrow.’ Likewise, due to significant payment reductions in the PPACA, some seniors with Medicare Advantage plans are being forced to find new doctors. UnitedHealth, the largest provider of these plans, has recently reduced its provider networks in at least 14 states.
     “In addition to these network access issues, there is the impact of the PPACA on the health care workforce, in particular its effects on workforce shortages and greater administrative burdens.” (Ref. 4)

Medicare

     With respect to Medicare, President Obama promised:

“I will protect Medicare.”
Reality: “The PPACA cuts Medicare to offset new health care spending. The PPACA makes unprecedented and unrealistic payment reductions to Medicare providers and Medicare Advantage plans in order to finance the law’s new spending on subsidized coverage for the non-Medicare population. The cuts amount to over $700 billion from 2013 to 2022. If these draconian reductions take place as scheduled, they will significantly impact seniors’ ability to access treatments and the quality of their care." [Emphasis mine] (Ref. 4)

Senior Citizens

     How is Obamacare treating seniors in 2015? Last year, “the Obama administration boasted that Obamacare was improving health care quality for seniors. . . . But a closer look shows that they’re not improving care. They’re skimping on it, socking seniors with unexpected bills for ‘observation care’ and likely shortening their lives. [Emphasis mine] (Ref. 7)

     So how does Obamacare do this? Under one of the innumerable provisions of Obamacare, Section 15, hospitals get penalized if a patient has to be readmitted within 30 days of discharge. So, to avoid the penalty imposed by Obamacare, hospitals list the patient as being under “observation.” The patient will get the same tests and treatments and be put in the same room as if he were “admitted.” But, as long as the patient doesn’t stay in the hospital two nights, Medicare isn’t billed and the patient becomes responsible for the bill. The bill for a two-day stay in a hospital, with a full battery of tests and procedures, can be astronomical. And many of the seniors caught in this paper shuffle aren’t even aware that they haven’t been “admitted” and instead are “under observation” until they get socked with the bill.

     So, not surprisingly, “fewer seniors discharged from the hospital are returning for additional care within a month’s time.” (Ref. 7) And also, not surprisingly, there has been a concurrent rise in the number of “elderly patients placed under ‘observational status.’ It’s a hospital billing trick {fostered by Obamacare} and a dirty one for seniors.” (Ref. 7)

     Obamacare was touted as a great health care improvement for seniors and the poor. But 5 years into Obamacare, the results are not bearing out the promises made. The readmission penalty is impacting some seniors, but the poor are also getting shortchanged since, “hospitals caring for the poor are getting whacked hardest by Obamacare’s readmission penalty.
     “Penalizing readmissions is one of the laws’ ploys to reduce Medicare spending, never mind the impact on seniors. Cuts in future Medicare spending pay for over half the law, robbing Grandma to fund health coverage for other groups." [Emphasis mine] (Ref. 7)

     Another section of Obamacare, Section 3001, rewards hospitals with “bonus point” for improving the “value” of the health care they provide. But, “Don’t trust Obamacare’s definition of ‘value’ . . . Obamacare defines it in a way that produces the opposite: dangerously skimpy care for seniors. . . . {T}he lion’s share of bonus points go to hospitals that spend the least per senior.
     “That cost-cutting will shorten lives. [Emphasis mine] Evidence form 208 California hospitals shows that Medicare patients treated in the lowest-spending hospitals had a worse chance of surviving their illness and going home than patients with the same diagnosis treated at higher-spending hospitals. . . .
      - - -
     “Ignoring this evidence, Obamacare incentivizes hospitals in all 50 states to imitate low-spending hospitals that are deadly for seniors. That’s some definition of value.” (Ref. 7)

Children and Individuals with Special Needs

     Obamacare is also reported as adversely impacting the health care of children and individuals with special needs. (Ref. 8) Some of the problems that have resulted from the implementation of Obmacare and are reported in this reference are summarized as follows:

     It often takes more time and effort to provide medical services to children with special needs. Because of this, some health care providers may discourage parents from seeking treatment by requiring very long waits to get an appointment. Medicaid reimbursement rates are so low that many private doctors refuse to accept them. Doctors must also deal with a huge amount of paperwork. Families that can afford coverage under their private insurance are adversely impacted by Obamacare which prohibits insurance companies from charging higher premiums to those with pre-existing medical conditions. The only way the insurance companies can cover the costs of servicing special needs patients is by squeezing the reimbursement to doctors and facilities. The insurance providers have also ruthlessly been reducing the size of their provider networks by eliminating the highest cost providers. Consequently, doctors must reduce their charges to avoid being thrown out of the insurer’s network and this means spending much less time with special needs patients. This hurts most those patient that need more time and care – those with special needs. Because Obamacare has vastly increased the number of Medicaid recipients without a corresponding increase in the number of physicians, it is now much more difficult to find doctors willing to take on special needs patients with Medicaid coverage. The long delays in obtaining treatment are a form of health care rationing intended to reduce costs by discouraging people from using the system. Such delays are more than an inconvenience – they can be life-threatening. Similar delays have been imposed by Obamacare regulations throughout the health care system in such areas as providing patients with vital Health care supplies and equipment. Unfortunately the choices and availability of health care for children with special needs are likely to get worse in the years ahead, as more doctors close their private practices and retire or go to work for large hospital-owned clinics. Obamacare policies are deliberately intended to limit patient access to only the least expensive health care providers – no matter what is the adverse impact on patients with special needs and others.

     Parents of special needs children have seen their tuition costs increased by Obamacare through the capping of their Flexible Spending Accounts, FSAs, as was noted earlier. “{T}uition for special-needs education . . . can be claimed as a flex-account reimbursement expense. Children with severe developmental disabilities often require special education that can run well in excess of $10,000 per year in tuition. Thus, the FSA cap hurts families with special-needs children.” (Ref. 9)

     Former Republican vice presidential candidate Sarah Palin pointed this out in 2010 when she “warned that new rules aiming to raise $13 billion by limiting contributions to flexible spending accounts amount to a ‘hefty tax hike’ for families of special needs children struggling with health care costs. And she said families will wind up with fewer care options.
     "’Our insurance and our care choices will be diminished by this new program,’ she said. . . . ‘The government's taking over one-sixth of our economy and we expect the government's going to do a better job than the private sector?’” (Ref. 10)

Quality of Medical Services Under Obamacare

     “Hospitals throughout the country are evaluated, and penalized, based on a variety of statistics, everything from the mortality rate of heart attack patients to whether the hospital uses certain best practices.
     “But researchers at Tufts Medical Center {in Boston}said some metrics, given increased prominence thanks to the Affordable Care Act {Obamacare}, may be doing more harm than good.
      - - -
     “For example, hospitals are encouraged to use beta-blockers in non-cardiac surgery and glucose control in critically ill patients.
     "Though initial research showed that the interventions could reduce mortality risk, more recent, larger-scale studies showed both practices could increase mortality. Despite the findings, the {Obamacare} mandates remain. [Emphasis mine]
     “Others are being penalized for offering better care – for example, under the mandates, hospitals are penalized for patients that have blood clots, which doesn't provide an incentive for hospitals to go looking for blood clots.” [Emphasis mine] (Ref. 8)

     Clearly, letting government bureaucrats make decisions about health care procedures under Obamacare rather than having these decision made by health care professionals is proving detrimental to some patients’ health – not a desirable outcome! For reason like these, opponents of Obamacare trust individuals and the health care providers - not the government - to be the key decision makers.

Some Light Shining Through the Clouds

     All news on the Obamacare front in 2015 is not bad. For instance, if you like your health insurance plan, you actually might have been able to keep it this year.

     “Fewer than 1 million Americans had their health insurance plans canceled for 2015 for noncompliance with Obamacare rules . . .
      - - -
     “In the individual insurance plan market, just 400,000 people, or 2.2 percent of the overall market, had plans canceled after they received a letter citing lack of Obamacare compliance for the action. Another 3.4 percent, or nearly 600,000 people, were canceled for unknown reasons, the report found.
      - - -
     “The report said that another 500,000 people who had insurance through their job, so-called group coverage, had their health plans canceled for 2015 explicitly due to lack of compliance. That represents just 0.3 percent of the total employer-based insurance market.
     “Even with the cancellations, the rate of people without health insurance in the United State continues to hit record lows.
     In another report, the Urban Institute found that the rate of non-elderly adults without insurance as of last December {2014} was just 12.8 percent, compared with 17.7 percent in September 2013, on the eve of the launch of Obamacare insurance marketplaces. The drop in the uninsured rate is due largely to an increase in the number of people covered by the government-run Medicaid program and by sales of individual policies on the Obamacare exchanges. [ 11]

     There is still othere favorable news about Obamacare as reported in mid-2014.

     “Despite the cries of the Obamacare bashers that insurance companies would leave the exchanges in droves once they discovered how much money they are losing , it turns out that competition and choice are increasing as we head into 2015.
     “According to {one} study, ‘In the 41 states releasing exchange participation carrier data, the number of health insurers increased by 26 percent between 2014 and 2015. In the 19 states with complete fillings, the number of products grew 66 percent, with most in the silver tier.’
     “{And while} 65 percent of existing policies will see an increase in premium costs for 2015, the median increase will be just 4 percent.” (Ref. 12)

One Quick Assessment

     Toward the end of 2014, the New York Times looked into the question of whether or not Obamacare was working (Ref. 13). The results reported are summarized below.

     Has the percentage of uninsured people been reduced by Obamacare? Yes - The number of Americans without health insurance has been reduced by about 25 percent in 2014.

     Has insurance under the law been affordable? Maybe, the results are mixed. Subsidies have lowered costs for many, but others have seen their premiums rise. 85% of those who signed up during the enrollment period qualified for federal subsidies to help pay premiums. As expected, this helped lower costs for the poor.

     Did Obamacare improve health outcomes? The answer to this question is that no one knows at this time. As reported elsewhere in this article, there is some evidence that health care is deteriorating under Obamacare, while there does not seem to be concrete evidence of improvement.

     Has the health care industry been helped or hurt by the law? Obamacare seems to have helped the health care industry. The industry appears to be largely flourishing, in part because of the additional business that Obamacare has created. Hospitals are being hurt by a provision of the law that cuts their Medicare payments by $260 billion over 10 years. But they have benefited from having more insured customers who can pay their bills.

     How has the expansion of Medicaid fared under Obamacare? In some states Medicaid has expanded under Obamacare, But all, is not rosy. With so many new people in the expanded program, a question has emerged: Are there enough doctors to serve them? Many urban and rural areas were already struggling with shortages of doctors willing to take Medicaid patients before the law took effect. Beneficiaries have reported serious problems obtaining the care they need, particularly specialty care.

     Has Obamacare contributed to a slowdown in health care spending? The rate of increase in health care spending has slowed in recent years, but probably not because of Obamacare. The spending slowdown began before the Obamacare law was even written. The law’s main initiative has yet to demonstrate the savings its authors promised.

But

     five years after Obamacare became law, whether it is a success or failure is unclear. When one tries to definitively assess its impact on American health care, one is forced to describe Obamacare with an overabundance of the conjunction “but”.

• A greater percentage of Americans now have health insurance than ever before,
  but the health care they receive may not be very good health care and they may experience very long wait times to receive their health care.
  
  
• Some people have been able to keep their doctors,
  but others have had to receive medical services from new physicians.
  
  
• Some people have been able to keep their old health care providers,
  but other have had to sign up with new insurers and use the services of new hospitals.
  
  
• Some say that Obamacare is reducing the rate of cost increase of health care,
  but there is strong evidence that the reduction in the rate of health care cost increase was occurring well before Obamacare took effect.
  
  
• Premiums for health care insurance were not supposed to increase under Obamacare,
  but while premiums for some have not increased or even decreased, many others have seen their premiums rise.
  
  
• Obamacare was supposed to be introduced seamlessly with minimal disruption,
  but, as has been well documented, the roll-out of the sign-up system for Obamacare was a disaster and many people are still experiencing unexpected problems and delays trying to sign up for their health care coverage.
  
  
• It was promised that Obamacare would protect vulnerable patient populations by preventing them from being charged more because of a pre-existing condition or getting fewer benefits like mental health services or prescription drugs,
  but drug costs for these patients have skyrocketed and the majority of health plans offered on the exchanges have shifted costs for expensive medications onto patients.
  
  
• Obamacare was not supposed to increase the federal deficit,
  but this has clearly proven to not be reality.
  
  
• It was claimed that Obamacare would not create tax increases,
  but in reality, there have been a number of tax increase resulting, directly or indirectly, from the PPACA.
  
  
• Obamacare was supposed to protect Medicare,
  but PPACA cuts Medicare to offset new health care spending, while making unrealistic payment reductions to Medicare providers and Medicare Advantage plans in order to finance subsidized coverage for the non-Medicare population.
  
  
• The quality of health care under the PPACA was not supposed to decline,
  but there is mounting evidence that health care quality is decreasing because of ill-considered Obamacare mandates and reductions of payments to health care providers.
  
  
• The PPACA is helping many at the bottom of the income ladder with their health care costs,
  but others, like seniors, or individuals with special needs are finding their costs are increasing and/or the quality of their health care services are being lowered under Obamacare.
  
  
• Medicaid, in some states, has expanded under Obamacare,
  but there may not be enough doctors to handle the increase in the number of the newly enrolled. There is a growing shortage of doctors willing to take Medicaid patients and it is reported that many doctors are retiring early, with an insufficient number of new physicians to replace them.
  
  

1. Obamacare: Voters, are you stupid?, Jeremy Diamond, CNN , 18 November 2014.
2. HEALTH DISCONNECTOR, Chris Cassidy, Boston Herald, Page 7, 24 March 2015.
3. Health costs up, overall quality down, Sally C. Pipes, Boston Herald, Page 17, 19 March 2015.
4. A Fresh Start for Health Care Reform, Edmund F. Haislmaier, Robert E. Moffit, Ph.D., Nina Owcharenko, and Alyene Senger, The Heritage Foundation: Backgrounder #BG2970 on Health Care, 30 October 2014.
5. Obamacare 2015: Higher costs, higher penalties, Aimee Picchi, MONEYWATCH, 12 November 2014.
6. Obamacare sticks some enrollees with unexpected bill, Dan Mangan, CNBC, 10 April 2015.
7. Medicare cuts rob Grandma to fund Obamacare, Betsy McCaughey, Boston Herald, Page 13, 26 May 2014.
8. Health Care Availability for Special Needs is Under Siege, Yaakov Kornreich,
   Building Blocks, A Special Needs Magazine, Pages 10-12, June 2014.
9. Obamacare’s four tax hikes on young adults and kids, Grover Norquist, The Daily Caller; http://dailycaller.com/2012/03/20/obamacares-four-tax-hikes-on-young-adults-and-kids/ ,
   Accessed 4 July 2014.
10. Palin: Health Care Overhaul to Hurt Special Needs, Newsmax, 29 June 2010.
11. Fewer people lost 2015 health plans due to Obamacare, Dan Mangan, CNBC, 13 March 2015.
12. Key Study On Obamacare 2015 Premium Rates Is Out And You Won't Believe What's Going To Happen,
    Rick Ungar, Forbes, 31 November 2014.
13. Is the Affordable Care Act Working?, Troy Griggs, Haeyoun Park, Alicia Parlapiano, Sona Patel, Karl Russell, and R. Smith, The New York Times, 26 October 2014.
14. Happy 5th birthday Obamacare, now what?, Stuart Butler, Fortune, 24 March 2015.
15. Report: Some federal hospital mandates could be putting patients at risk, Jessica Bartlett,
    Boston Business Journal, 3 April 2015.