We were told ObamaCare is not socialized medicine. Proponents assured us that ObamaCare would simply quell problematic insurance practices such as medical underwriting and preexisting condition exclusions. System-gaming would not break the insurance industry as the individual and employer mandates would prevent such catastrophic industry failure inherently at play in any law that guarantees coverage while reducing the ability to manage risk (insurance is, after all, the buying and selling of risk).

Now the Obama Administration has unilaterally proclaimed success with a reported 8 million exchange enrollees. Game, set, match; drop all opposition as the battle has been won, we are told. Sounds like claiming a win before the first pitch is thrown. 

What matters is not the number of enrollees as of April 2014. The real issue is how ObamaCare will impact healthcare in the long haul. The true effects will take some time to rear their ugly head but, like rabies, once symptomatic it’s too late for any vaccine to work.  

What better way to gauge the future impact of ObamaCare than to review the words of one of the law’s principal architects, Dr. Ezekiel Emanuel?  Dr. Emanuel recently wrote a New Republic article titled, “Insurance Companies as We Know Them Are About to Die”. Moreover, in his book, Dr. Emanuel predicts that less than 20% of workers will receive employment-based coverage by 2025. 

Wait a minute, if employment-based coverage will drastically decrease and insurance companies will cease to exist, what will the end result be?  Who will provide healthcare coverage in the long haul? Could it be that ObamaCare really will take us down the road to single payer? 

Think about the employer mandate, which has already been delayed twice; first on July 3, 2013 to 2015 and then again this past February, when the U.S. Treasury Department delayed the mandate for mid-sized employers (50 to 99 full-time employees) and softened the penalty for large employers (100+ full-time employees) to 2016. This means that while proponents may celebrate 8 million signups, we will not see the number of jobs that will be impacted because of the law, or the number of individuals who will lose their employment-based coverage, until after 2016 (and what happens in November of 2016?). As the full employer mandate kicks in and hours are cut and jobs are eliminated (or outsourced), or employers simply choose to pay the cheaper penalty, the middle class will feel the sting.  As Dr. Emanuel predicts, less than 20% of workers will receive employment-based coverage in the next decade. Incidentally, most members of the middle class will not be eligible for top tier subsidies, if they will be eligible at all. Thus the middle class will become the new face of uninsured in America.        

Medicaid eligibility has been dramatically increased (and devoid of reasonable checks such as obligations to seek employment or utilize care in the most appropriate setting); lower earners quality for substantial subsidies. Who foots the bill? The middle class, the same group who will lose their employment-based coverage over the next ten years. Imagine working hard for benefits to see them blow away with the wind. To rub salt into the wound, ObamaCare then imposes a tax because you cannot afford the inflated price for coverage caused by the law itself. Talk about squeezing the middle class into submission on the socialized medicine issue.         

Nancy Pelosi said, “We have to pass the bill so that you can find out what is in it.” It looks like we will have to wait even longer. Let’s just hope we come to our senses before it’s too late.