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  • 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 …
  • Ralph Weber Talks About Cost Shifting – Video September 17, 2014
    How do hospitals come up with their prices? Medicare patients cause them to lose money. They have to make up the difference by charging the self-insured more. Non-profit hospitals keep beds vacant or build other facilities so as not to …
  • Here’s The Thing #4 Cost Shifting HD September 17, 2014
  • The Commoditization of Medicine September 17, 2014
    Parvez Dara, MD, FACP, MBA, author of http://jedismedicine.blogspot.com/, speaks at the AAPS 71st Annual Meeting in Charleston, SC.
  • The Progressive Train Wreck: From Medicare to HillaryCare to ObamaCare September 15, 2014
    Jane M Orient, MD presents at the AAPS 71st annual meeting, September 5, 2014, Charleston, SC.
  • Varying Prices for Lab Tests are Absurd September 15, 2014
    by Adrienne Snavely The health needs of a community vary by market. If you cannot find what you need or afford it, you should have the opportunity and information to go elsewhere without being penalized. A patient in Chicago went …
  • The Future Of Medicare September 14, 2014
    Lawrence R. Huntoon, MD, PhD presents at the 71st Annual Meeting of the Association of American Physicians and Surgeons, September 6, 2014, Charleston, South Carolina.
  • Unethical ABMS behaviors and the MOC Scam: How It Will Be Used to Control Medical Practice September 13, 2014
    Paul Kempen, MD, PhD presenting at 71st annual meeting of AAPS, September 6, 2014, Charleston, SC.
  • How is that low fat diet working out for you? September 12, 2014
    by Sue Redmond First, let’s ask where did the idea for the low diet come from? In the late 50’s and early 60’s the AMA worked on a theory and published a report that a low fat diet could help …
  • EHR: Remote Control – Craig M. Wax, D.O. September 12, 2014
    Dr. Wax of http://ip4pi.wordpress.com examines how government-controlled electronic health records undermine quality medical care and patient privacy. Presentation at 71st Annual AAPS Meeting Sept. 4-6, 2014.
  • Evidence-Based Medicine as Junk Science — Twila Brase RN September 11, 2014
    Twila Brase, President of http://CCHFreedom.org outlines how so-called evidence-based medicine (EBM) encourages one-size-fits-all healthcare, is a tool for increased control by insurance companies and the government, and is detrimental to individualized patient care.
  • What ObamaCare Means for Patients September 11, 2014
    Kris Held, MD addresses the 71st Annual Meeting of the Association of American Physicians and Surgeons, September 4, 2014 in Charleston, SC.
  • Private Health Care is Individualized Care, Not Public Health — Richard Amerling, MD September 10, 2014
    AAPS President-Elect Richard Amerling, MD opens the 71st Annual Meeting, Sept. 4, 2014, Charleston, SC.

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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