ObamaCare's future: 11 ways the health care law could be dismantled in 2015

“Everything you have seen here has been an illusion.” Those are not the words of President Obama. But given what we now know about ObamaCare, they well could have been.

Instead, they are the words of Eisenheim, a 19th century master magician in the fictional film, “The Illusionist.” And, just like Obama, he uses his abilities to fool the masses into believing that his artifices are quite real.

The president sold his health care plan on the promise that it would help Americans who had no insurance, but all others would remain unaffected. It proved to be an illusion.


Millions of Americans lost their insurance, their doctors, and their hospitals. Average premiums did not go down by $2,500, as promised. They went up appreciably, rendering the term, Affordable Care Act,” an oxymoron.

The tax was cleverly disguised as a penalty because, as Jonathan Gruber the so-called architect of the ACA confessed recently, Americans are stupid. And the quintessential cover-up obscured the identity of those who would pay for it:young, healthy individuals subsidizing older, sick people. It was a scheme of deception designed to fool Americans. An artifice. In a court of law, it would be called fraud.

Either the president knew his promises were untrue and deliberately set out to deceive Americans or he inexplicably believed it was true but did not bother to read or understand the bill he signed into law. Which means he was both naïve and incompetent, but slightly better than malicious. No mea culpa will ever undo the damage.

What can be undone are key parts of ObamaCare. Republicans are vowing to try. Some Democrats, fraught with buyer’s remorse, may join them.

All the impassioned rhetoric about repealing ObamaCare in its entirety is nothing more than political phantasm.The new Senate does not have a veto-proof majority of 67 votes. It's simple math.

Republicans will, of course, pursue the charade because that is one of Washington’s quaint traditions. But once the symbolic pretense is over, the new Congress may go about disassembling ObamaCare, piecemeal. How exactly? Here are some of the ways:

1. Revisit the employer mandate. Under ObamaCare, companies with at least 50 full-time employees are required to provide insurance. Under pressure from businesses and even members of his own party, Obama delayed implementation. Republicans would like to kill it completely, but this is a long shot.

2. Revisit the individual mandate.All Americans are forced to buy health insurance or face a tax penalty. Although it remains the most unpopular part of ObamaCare, the Supreme Court narrowly upheld this provision. Removing it from the health care law would undermine the premise and financial stability of ACA which means the president would surely put ink on a veto. So this is the longest of long shots.

3. Repeal the medical device tax. The tax on medical devices helps generate revenue to pay for low-income subsidies. But the 2.3 % tax also hurts manufacturers and has a negative impact on the economy. There is bipartisan support for repealing the tax and it probably has the best prospect of passage.

4. Revisit what constitutes "full time" employment. Changing the definition of “full time” employee from 30 hours to 40 hours per week would allow many businesses to hire more people without being forced to provide employer coverage. It would help stem job losses caused by the law. This idea is gaining traction.

5. Federal reimbursements. The federal government is required to reimburse insurance companies when their costs end up higher than anticipated. Derided as a blatant “bail-out,” it could be on the chopping block.

6. Medical board. Written into the ACA law is an Independent Payment Advisory Board which oversees health care pricing.The much maligned board has yet to be activated, so repeal stands a decent chance of happening.

7. Lowering subsidies. ObamaCare could be made more affordable to the government if subsidies given to low-income enrollees were reduced. Obviously, this would increase the cost to participants, but modifying the subsidies has some support.

8. New “copper” plan. Creating a new, lower cost category of ObamaCare coverage would reduce the high price of premiums, but increase out-of-pocket expenses born by participants.This would attract those who must comply with the law but desire the lowest cost available. It might also spawn creation of additional low cost plans which consumers crave. It is doable.

9. Withhold funding.Not all ObamaCare funding is mandatory.Some administrative costs, for example, are funded through discretionary appropriations. Congress could vote to stop funding for certain provisions, making full implementation difficult. However, the president could veto such a spending bill even in the face of another government shutdown.

10. Republican alternatives.With both houses of Congress now in its control, the GOP will likely intensify the push for its own alternative ideas: bills that would allow people to purchase insurance across state lines to increase competition and lower premium prices, promote health savings accounts, permit small businesses to “pool” their employees together to gain better insurance rates and coverage, tax credits for those individuals without employer provided insurance, limiting medical malpractice awards which are a driver of overall health costs, and Medicaid reform.

11. Supreme Court decision. Beyond congressional action, the U.S. Supreme Court is poised to hear a formidable challenge to ObamaCare which could seriously destabilize the law. A key provision requires that subsidies be given to eligible individuals enrolled through an “exchange established by the state.” It was purportedly designed as an incentive for states to set-up their own exchanges. However, 37 states chose not to do so, relying, instead, on federal exchanges. Supporters of ObamaCare claim it was merely a hasty mistake -- some have called it a "typo."

If the high court disagrees by ruling that some 5 million people on federal exchanges are not eligible for financial assistance under the plain meaning of the statute, this could shatter the financial underpinnings of ObamaCare.

Of course, predicting how the Supremes will rule is a fool’s errand. But one thing is certain, the president cannot now go back to Congress to try to fix the textual language of his signature achievement. Republicans will control both houses in 2015.

There have been 42 significant changes to ObamaCare so far, 24 of them ordered unilaterally by the president. Setting aside the question of his legal authority to do, all these revisions underscore what an ill-conceived and poorly crafted law this was from the outset. But it also belies another promise averred by Obama that his new law would be fair.

It is hardly fair to enforce the mandate on individual Americans, while granting a myriad of waivers, exemptions, exceptions and delays for select businesses and unions who supported the president.

Polls show that Americans were overwhelmingly against ObamaCare before it ever passed.Their antipathy has remained constant, as people continue to recoil from an unpopular law that deprives them of their freedom of choice in matters which are inherently personal -- their health. They resent such decisions being made for them by their government. A new Gallup poll finds a majority of Americans (56 %) disapprove of ObamaCare, while 37 % approve.

Obama has only himself to blame for the manifest flaws in his grand illusion. Driven by an authoritarian impulse, he forced ObamaCare through a compliant Democratically controlled Congress, never giving anyone a chance to digest the 2,700 page bill and what it might portend for America.

Obama’s promised transparency was a concomitant fraud epitomized by then-House leader Nancy Pelosi when she sputtered one of the most baffling and incomprehensible lines in American politics, “we have to pass the bill, so that you can find out what’s in it.”

Well, now we know.

The wreckage wrought by ObamaCare is strewn across the landscape of American lives. People have seen their premiums rise, deductibles escalate, benefits decline, quality of care diminish, plans cancelled and doctors vanish.

For what? When he began his first term, President Obama vowed his health care law “will cover every American.” Yet, 41 million Americans are still uninsured.Is the law worth the $2 trillion dollars in taxpayer expense and the loss of 2.5 million jobs, as estimated by the non-partisan Congressional Budget Office?

Our president thinks so. He insists he is proud of the pejorative, “ObamaCare.” If so, he is a modern-day Eisenheim, America’s “illusionist,” fooling no one but himself.