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  • Physicians are Not Medicine’s Top Earners October 24, 2014
    Physicians are the most highly trained members of the medical industry’s force, yet have median compensation.  The largest salaries go to the Medicrats who oversee the business of medicine. Insurance CEOs average $584,000 compared to surgeons ($306,000) or a general …
  • Health Benefits of Honey October 22, 2014
    Honey has been used as a natural sweetener long before sugar. Bees collect pollen from  plant to plant, which is passed along from bee to bee until it eventually is deposited into the honeycomb. They beat their wings to evaporate …
  • Rotten Food and the VA Hospital October 20, 2014
    by G. Keith Smith, MD Imagine for a moment that you own and operate a restaurant knowing that if you provide spoiled food and rotten service, you will subsequently make more money.  You openly employ strong-arm and intimidation tactics to …
  • Hospitals want patients to pay in advance October 17, 2014
    Hospitals are asking for payments from patients before they leave the facility so they don’t end up with unpaid bills. Knowing the costs before the procedure is important because insurance deductibles are increasing and so are procedure costs. Obamacare policies …
  • State Highlights: Mass. First To Require Health Care Price Tags; Health Disparities In Wis. October 15, 2014
    A selection of health policy stories from Massachusetts, Wisconsin, Illinois, Connecticut, California, Texas, South Dakota and Pennsylvania. WBUR: Massachusetts Becomes First State To Require Price Tags For Health Care Massachusetts has launched a new era of shopping. It began last …
  • Physicians Remove Government from Medical Equation October 13, 2014
    by Gerard Gianoli, MD Doctors in Nevada and across the country are protesting against the government’s intrusion into health care, but we aren’t voicing our concerns using bullhorns and pickets. Instead, many of the state’s 5,400 physicians are protesting silently …
  • Revolutionary Idea Could Change Medicine October 10, 2014
    For those of us who get woozy when having blood drawn for routine testing, a simple pin prick may be the blood test of the future. Elizabeth Holmes, the CEO and founder of Theranos, says that her company can run …
  • Why Accountable Care Organizations Are Failing October 8, 2014
    by Richard Amerling, MD Accountable Care Organizations (ACOs), a key piece of the Affordable Care Act (“ObamaCare”) “reform” plan, are failing because they must fail. ACOs are based on faulty assumptions, poor economics, and junk science. They would not exist …
  • Common Sense Travel Restrictions to Stop Ebola: Dr. Jane Orient October 7, 2014
    Dr. Orient appears on Cavuto – October 6, 2014
  • What Employers Can Do To Reduce The Cost Of Obamacare October 6, 2014
    The Obamacare mandate will be enforced on large employers in 2015 and small employers in 2016. Large companies who self-insure can have a plan that does not cover hospitalization, mental health care, or emergency room visits.  Small companies have to …
  • Ralph Weber Talks About Fixed Pricing – Video October 3, 2014
    You can ask the price of a procedure at a hospital, but may ask several different people before finally getting an answer. Listing set prices for procedures has lead to medical tourism. People will travel to get the price they …
  • Here’s The Thing #5 Fixed Pricing HD October 3, 2014
  • Economists Say Third-Party Payment Key to Increases in Medical Cost October 1, 2014
    The rapid increase in medical costs starting in the 1970s is commonly ascribed be market imperfections. However, federal and state governments have long suppressed the functioning of the market system in the medical industry, write Maureen Buff and Timothy Terrell, …
  • Health Insurance Exchanges Waste Taxpayer Money September 29, 2014
    Obamacare may surpass Cash for Clunkers to become the prime example of federal taxpayer resource mismanagement. For every dollar in premiums for exchange coverage, taxpayers paid 94 cents in subsidies to either enroll people or encourage them to do so. …
  • Mesothelioma: An avoidable cancer? September 26, 2014
    by Sue Redmond Did you know? Mesothelioma is an aggressive cancer that attacks the lining of the body cavity called the mesothelium (80% of which occur within the lining of the lungs). The only known cause to mesothelioma is exposure …
  • Government Healthcare is Breech of Contract September 24, 2014
    by G. Keith Smith, MD One of the smartest people I have ever met is a property and contracts lawyer, someone from whom I have gleaned countless and valuable insights over the years.  He has advised me, among other things, …
  • Dr. Alieta Eck Campaign Update September 24, 2014
    Dr. Eck http://EckForCongress.com speaks to colleagues at AAPS 71st annual meeting on September 5, 2014.
  • Is There A Provider In The House? September 22, 2014
    by Marilyn Singleton, MD, JD Physicians have a proud heritage. We can boast Dr. Benjamin Rush, a founding father, signer of the Declaration of Independence, Surgeon General of the Continental Army, and opponent of slavery. And Dr. James Derham, born …
  • From EBM to Guidelines September 20, 2014
    Richard Amerling, MD presents at the 71st Annual Meeting of the Association of American Physicians and Surgeons, September 5, 2014.
  • Flaw In Federal Software Lets Employers Offer Plans Without Hospital Benefits September 19, 2014
    A flaw in the federal calculator for certifying that insurance meets the health law’s toughest standard is leading dozens of large employers to offer plans that lack basic benefits such as hospitalization coverage, according to brokers and consultants. The calculator …

The Cliff Effect: Obamacare Takes a Double Shot at the Economy and the American Dream

Subsidy Cliff Effect in Health Care InsuranceThe ‘cliff effect’ described here is something I’ve been worrying about for more than a year now.  Based on Kaiser’s calculator using my age, earnings and location, I’m in a spot where a tiny increase in income will have a dramatic effect on the subsidy I might get.  But what scares me is that it isn’t just me, it is that everyone like me will be faced with this, and many will be blindsided by it, which isn’t fair at all.  Like described below, a small shift of an annual income, say an additional $500 per year, or even $5 if I were that close to the marker (which shifts constantly), could push someone like me into the next bracket for subsidy, reducing the subisdy by thousands.  The situation below is extreme, but possible.  When I calculated it out (read more of my calculations here), I found that the subsidy drop off was much more drastic than the increase of income needed to produce it.  Which means someone can get a pay raise, only to find themselves without enough money to pay their health insurance premium anymore, let alone pay that and the rent.  This pay raise becomes a false sense of security, and most people celebrate getting a raise, which would only put them in debt in these cases.  I think this is horrible.  Only those who have benefits through their employer are safe from this cliff.


From the Foundry.  Click here to read the entire article.

Beginning in 2014, when the new health insurance exchanges will open for individuals and small businesses, subsidies will become available for those whose income falls between 134 percent and 400 percent of the federal poverty level (FPL). For a family of four living in a high-cost area, earning 134 percent of the FPL ($31,389 in 2014 dollars) would qualify them to receive $22,740 in assistance. A similar family earning an income at 400 percent FPL ($93,699) would qualify to receive $14,799 in subsidies.

The problem is that as income increases, families will experience large reductions in government assistance, which will discourage striving to earn a higher income. According to Kessler, “Economists call large, discontinuous changes in program benefits like this ‘notches.’ Although notches might be administratively convenient, they have terrible incentive effects.” One of these is “a substantial punishment on work effort.” If a member of a family of four living at 400 percent of FPL earns just $1 more, they would receive no subsidy at all, making the family almost $15,000 poorer. This “cliff effect” will have profound implications on the labor market. Heritage analysts Brian Blase and Paul Winfree write, “the subsidy structure creates incentives for individuals to engage in unproductive activities, such as working less and retiring early.” These income “cut-offs,” which already present issues in Medicaid, induce sharp reductions in the labor supply—not good when the economy is already struggling to recover.



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