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Regime Delays Obamacare Cost Caps for Those Who Qualify to Put Off Premium Hikes on Everyone Until After the Midterms

BEGIN TRANSCRIPT

RUSH: The strangest thing.  To me it was the strangest thing.  I had to double down -- and I'll admit this to you.  I probably shouldn't admit this to you, because I am the hardest working man in the "know business," and it means I know.  But there was something that had me temporarily stumped today.  And it's the news -- it's been out there for a while, just nobody picked up on it -- the news that the regime has delayed the caps on out-of-pocket expenses and Obamacare.  And it confused me, because those are consumer cost protections.  See, the whole language confuses me.  Caps on out-of-pocket expenses.  What is an out-of-pocket expense?  'cause to me it's all out of pocket.  I pay for all of it. 

I don't use my health insurance.  I just don't.  I don't even know if I have any.  If I do, I don't use it.  So it's all out of pocket to me, so -- (interruption) well, I know.  I mean, I'm gonna be joining the hoi polloi now. I mean, I may as well become a congressional staffer and maintain my current health care status.  Anyway, it's all out of pocket to me, so what does this mean, out-of-pocket expense?  Who's capping what?  What's being capped, and why is this such a big deal?  I mean, I had to do a crash education course for myself today. 

And what I have figured out, here's the real reason I was confused, it's because it's been delayed 'til 2015, and these are consumer cost protections that have been blown out.  These are the insurance companies being protected.  The evil insurance companies are the ones that get this benefit.  And I'm thinking, "Why do this prior to the 2014 midterms?  Why not do something that keeps costs down for voters?"  This is gonna cause everybody's insurance cost in every way you can imagine to skyrocket, because the insurance company can now make you pay anything they want out of pocket.  There aren't any caps on it. 

Obamacare is called the Affordable Care Act.  This was the affordable part, the consumer cost protections, the caps on out-of-pocket expenses.  The caps on what you were gonna have to pay, that was the "affordable: or is the "affordable" in the Affordable Care Act.  So what Obama has done -- and as the New York Times tells us, by the way, this has been up on a government website for months, but it was mixed in with a bunch of legalese and mumbo jumbo and nobody caught it, they didn't trumpet it, but the insurance companies here are getting a break, not the consumer, and that's what had me confused about this. The employer mandate has been delayed, and that, of course, the employer mandate requiring the employer to provide you insurance, that's been delayed. 

Now the out-of-pocket caps, which are the consumer cost protections, they've been delayed.  And, remember, before all of this, whenever you went into an exchange, you had to prove somehow that you qualified for a subsidy.  You don't.  You can go into an exchange 'cause that's been delayed, too.  None of this is being implemented on time, because it's unworkable, it's undoable, it's simply a mess.  It just can't be done. 

And here's the way the New York Times writes this: "In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care. The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014."

So what this means is that the ultimate promise of Obamacare to keep your costs down by limiting what the insurance company could demand you pay as your share of whatever treatment you get has been delayed.  Now the insurance company is not forced to set a limit on what you pay, and they cover the rest.  The insurance company can now charge you whatever.  They can raise your deductible. They can lower your deductible. They can get rid of your deductible.  Now, further investigation -- and I have to admit, I probably shouldn't do this, because I'm in the know business, and this is all foreign language to me. 

What this ultimately means is that when 2015 arrives after this delay, everybody's costs are gonna go through the roof.  Consumer, insurance company, that's what Obama is deferring.  The regime, what they're trying to do is to defer, 'cause they've told everybody their premiums are coming down $2,500.  They've told everybody that Obamacare is gonna lower the deficit and reduce the national debt, and what Obama has done is delay -- see, it's so convoluted.  The truth of the matter is that everybody's costs are gonna skyrocket.  That's the design of the plan, so that you can't afford private sector insurance and have to go to government. 

Single payer is what they want.  And the way they're gonna get you there is making it impossible to afford via insurance.  That's the objective.  It's always been the objective, to make it impossible for the average family to afford it.  They blame the private sector insurance companies for all the expenses, for all the costs, to set Obama and the government up as the saviors when that happens.  Well, that was supposed to start happening this year.  And, if the midterms were not so crucial and not so desirable and not so important to Obama they would have allowed this to implement. But instead the upshot of all of this is that the massive cost increases, the massive price increases on everybody, are being delayed here until 2015, until after the midterms. 

So this is just the next delay or waiver on implementation of Obamacare.  The employer mandate, the thing that required your employer to provide insurance, that's gone, that's delayed 'til 2015.  Obama wants your employer to stay in business one more year, because the employer mandate's gonna put a lot of them out of business, especially when the fines catch up with the cost of a policy.  And then the other big thing -- and there've been thousands of waivers for individual companies, as you know, but the other big thing that's happened is that the requirement that you prove that you qualify for a subsidy at an exchange, that's been broomed entirely.  Now all you have to do is walk into an exchange and tell whoever is there or online when you log in and do it there, that you qualify, and you do.  It's the honor system. 

The only people who are not affected by any of this are government staffers.  They are the only people unaffected, as you know.  Congressional staffers are gonna get their health care costs paid for to the tune of 75%.  Obama negotiated that personally for them after they whined and moaned and complained, remember?  They earn anywhere from 70 to $175,000 a year, and they said, "We can't afford what this is gonna cost."  Oh, that wouldn't look good.  Members of Obama's government can't even afford it, so they've made it affordable for them by subsidizing them maximum 11, $12,000 a year.  Now, how about these amounts here?  The limit on out-of-pocket costs, this is what you pay.  Insurance is gonna cover X, then the out-of-pocket, that's what you pay, the limit -- this has all been broomed now 'til 2015 -- but the limit on out-of-pocket costs, including deductibles and copayments, was not supposed to exceed $6,350 bucks. 

So you, or anybody, American consumer, was going to be responsible for at least $6,000 of your health care costs, maximum.  That was gonna be capped, and then whatever treatment you required above that, the insurance was going to pay.  That's now been broomed.  There is no cap, and if your treatment costs 12 grand, and the insurance company doesn't want to pay it, you're stuck.  And I'm still surprised that they're doing this, sticking it to the consumer, prior to 2014.  There are far more consumers than there are insurance companies.  But what they're really delaying here is massive costs increases for everybody that would implement with -- see, it's like water.  If you cap out-of-pocket expenses, you tell, you know, Mr. and Mrs. Enis Slobodnik out there in Pottawattamie, you know, Louisiana, you tell them that no matter what happens to them the most they're gonna have to pay is $6,000. 

Well, Mr. and Mrs. Enis Slobodnik are very happy, but if Mr. and Mrs. Enis Slobodnik incur expenses of 12 to $15,000, somebody's gotta pay it.  And guess who?  Those of you who pay and buy insurance.  Premiums would go up to cover this.  That is what is scheduled to happen.  When you put caps, when you tell some people that their costs are not gonna exceed X, when their costs do exceed X, somebody has to pay for it, and it's going to be covered by rising premiums for everybody.  That's what Obama is limiting, the rising of premiums, the increase in premiums to cover people who go above and beyond their caps. Have I made this somewhat understandable?  I hope.  See, the point is nothing is free, and we have a lot of people who think it is.  Nothing is free, and the caps were one of these artificial elements to make it appear as though it were affordable.

I still think, you know, for some people paying $6,000 a year in health care costs, it's gonna break their bank.  That is a lot of money for health care, and that was what the cap was.  You wouldn't have to pay any more than that, but now there's no cap.  They can charge you whatever, folks.  But the fact that there isn't a cap theoretically means that premiums won't go up on others.  So while costs are gonna go up for some, they're not gonna go up for everybody in the form of higher premiums, but next year, in 2015, they will.  Because the caps go into place, $12,000 for a family, $6,000 individual.  When the caps hit, that means some people are going to have their health care -- not insurance -- health care costs paid for.  Somebody has to pay for that.  And that'll be covered with increased premiums. 

Those premiums going up are what have been delayed.  And everybody has to have insurance, everybody, or pay a fine.  So what Obama has done is delay these rapidly rising premiums, which we're gonna face as a result of these caps, whenever this happens.  This is the affordable part of Obamacare, the caps.  The affordable part, for you.  And these consumer cost protections have now been delayed.  You are on your own.

BREAK TRANSCRIPT

RUSH:  Okay, now, we have some confusion here on the caps and what they are.  Now, the New York Times story mentions $6,000 for a single person, $12,000 for a family.  However, there's a story from Forbes today that quotes from the actual law, and it basically says section 2707(b), the Public Health Service Act as added by Obamacare requires that a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for any of the participant or beneficiary, anual limits on cost sharing are specified by section 1302. 

Starting in 2014, deductibles are limited to $2,000 per year for individual plans, $4,000 per year for family plans.  There's all kinds of mandates and regulations that are gonna make it more costly.  So what was going to happen, according to Forbes, starting next year, the caps would be $2,000 for a single person, $4,000.  I mean, that's all they would have to spend.  Everything above that would be covered by somebody else.  Who?  Well, everybody else that pays or buys insurance.  Premiums would have to go up to make this possible.  Qualification for these caps is quite large, by the way. 

The vast majority of the American people would see caps, not of $6,000 and $12,000, but of $2,000 and $4,000, at least on their deductible.  But that's not gonna happen.  That's been delayed.  Essentially there are no caps now, for all of next year.  So that $6,000 figure, the $12,000 figure that's in the New York Times, had the law been implemented, the numbers would have become $2,000 and $4,000, not six and 12.  Well, it doesn't mean that the expenses are going away.  It just means that certain people are not gonna be paying them.  And the way this was gonna be handled was through the miracle of premium increases on everybody who didn't qualify for these caps.  That's what has been delayed. 

BREAK TRANSCRIPT

RUSH:  If you are going to endeavor to read about this yourself, there are two stories out there today, and I would heartily recommend that you focus on the Forbes story 'cause I really think the New York Times story is purposely confusing and not complete.  I don't think the full picture is presented in the New York Times story.  Let me summarize for you.  I don't know about you, some of this language I have to really apply myself.  The whole notion of out-of-pocket caps on out-of-pocket expenses, I had to go to school on that.  And I've gone to school on it, I know what it is now, and here's the bottom line. 

The Forbes piece adds a lot of important data that the New York Times avoids.  And the most important takeaway on this news today is that once the insurance companies are no longer allowed to collect these out-of-pocket fees and deductions, they're gonna have to charge far more for the premiums.  And that's gonna make everybody's rate skyrocket, everybody.  So there is a huge advantage to the regime in putting that off until after the midterms. 

Here are the numbers.  The New York Times says that right now the cap on a single person is six grand -- I'm rounding off here -- and 12,000 on a family, those are the out-of-pocket expenses, the combination of what you spend at the pharmacy that isn't covered, your deductible and all of that.  Now, Obamacare, according to Forbes -- and they cite the law, where it's not their assertion, they actually quote from the law -- the actual limits on cost sharing specified by the law are $2,000 per year for individual plans and $4,000 per year for families.  So for whoever qualifies for this, the most out-of-pocket they can pay is either $2,000 or $4,000.  Well, their expenses, their actual expenses are gonna greatly exceed that. 

So who's going to pay for it?  Everybody, including them.  Everybody's premiums are going -- as long as there are insurance companies -- and I think this is a fundamentally important point to make as well, because right now that's where everybody is getting their insurance.  Even at the exchanges, the government is selling insurance, or offering it from private sector companies.  But fewer and fewer of them are participating, because it doesn't make any economic sense.  So if the trend continues, it isn't gonna be long before private sector insurance companies don't exist, which is the plan.  It's not next week, it's not next year, it's years out, but that's the plan. 

So what Obama has done, telling everybody, yeah, their costs are gonna go down, your premiums are gonna go down, at first there are going to be for certain people the maximum amount they will be forced to spend on whatever their health care costs are, is either $2,000 or $4,000, depending on they're single or family.  But let's just take the case of a single person, Enis Slobodnik, Enis has a debilitating disease, and it costs him $12,000 a year to be treated.  The most Enis is going to have to pay is $2,000 of it.  Somebody's gonna have to pay the 10 that he doesn't.  And it's gonna be everybody else, via rising premiums.  The insurance companies are not going to sit there and simply absorb this. Nobody would.  They're gonna go get the money that they have to spend somewhere, and they're gonna get it from paying customers.  Premiums are gonna skyrocket. 

Now, at some point the premiums are gonna get to the point nobody can afford it, at which point Obama or whoever, the Democrats are gonna ride it on their white horse and say these people are ripping you off.  This is not what Obamacare intended. We tried to rein them in, but they found ways around it to screw you and rip you off, so we're gonna come in and save the day, and we're gonna offer you cheaper alternatives here at our single payer window.  That's the ultimate plan here.  The thing that is confusing is that there really are two caps.  The annual, which is a cap on the deductible, which the consumer obviously wants to be as low as possible, and then there's a lifetime cap on total payouts, and the consumer wants that to be as high as possible.  And the lifetime cap is gonna be, I think, a million dollars, a million, a million and a half.  Once you've reached that, you're done. 

It's sort of like gift taxes and the IRS.  It may be incrementally higher now, I have to check, but over your lifetime you can give a total of a million dollars tax-free.  Once you exceed that, the tax on every dollar you give is like 43 or 44%, and you pay it, the giver.  Right now, you can give anybody $13,000 a year tax-free, but every time you do that's subtracted from your lifetime allowance of one million.  Most people, it's never gonna affect 'em.  The idea that people are gonna give away a million dollars, never gonna happen to the vast majority of people, but I simply use it as an example, because there's a lifetime limit on how much you can give tax-free.  And it's the same thing.  There's a lifetime cap on insurance that you don't have to pay, and I think it's a million, million and a half.  It's coming down. 

So there are two kinds of caps.  We're talking about the lifetime cap, and we're talking about the annual.  And it's the annual cap that I've been talking about here in the examples that I have been offering today.  But the bottom line is this.  The caps were supposed to come way down starting in January.  The amount of money individuals would have to pay on their own is gonna come way down.  That would cause premiums everywhere to skyrocket, noticeably so.  Everybody would notice it and get mad.  That is what has been deferred until 2015.  It looks like the insurance companies are being given a break here, at first glance.  The caps are not going down.  Individuals are still gonna be subjected to the current caps. 

And you would think going into the midterms that Obama, the regime, would take steps to make it easier on the consumer, 'cause there are a whole bunch of 'em, and they're voters.  And in truth, he is.  It's just that in giving the insurance companies a break here, what he's actually doing is putting off for one year what can only happen, and that is dramatically increasing health insurance premiums.  Because once the new caps go in much lower, somebody's gotta make up the expense.  That's what's been delayed for one year. 

So the practical result of this is that the huge expenses -- new expenses that everybody is going to feel with Obamacare -- I mean above and beyond what have already been felt, have been delayed until after the 2014 midterms, so as not to harm the president's party.  It's purely a cynical political ploy. Kathleen Sebelius, Health and Human Services director, is out there saying that this is not a bait-and-switch, but it is. 

Minor correction.  I got one thing wrong I need to straighten out.  Obamacare does away with the lifetime cap.  The current lifetime cap is one and a half million.  Obamacare does away with it.  Meaning there is no limit on how much the insurance company must help pay for your coverage, your treatment.  Right now there's a million and a half cap lifetime.  Now, it may sound good to you as a consumer, but you're gonna pay for it on the other end on higher premiums.  Money is money.  Costs are costs.  They're not going down.  Everything associated with health care is going up.  Everybody's going to have to pay it.  Obamacare is an attempted illusion to make a lot of people think they're getting a big break.  And we've had callers here.  You have people in your office the day after this thing was signed into law thinking it was free. 

You got all kinds of people out there thinking this isn't gonna cost them anything, or much, and it's gonna cost everybody a kit and caboodle, but not starting until 2015.  That's the basic sum of this.  Here is again, section 2707(b) of the Public Health Service Act, as added by Obamacare, requires a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for any participant or beneficiary.  So there will be no limits on how much insurance companies have to pay out, no limits.  Can't stay in business that way. 

Do you know how insurance companies make their money?  Do you know how they do it?  Do you know what they really do?  What do they do with your premiums?  That's right, they invest it in other things.  They're bookies, in a way.  I mean, they're legalized bookies.  But they're making a bet with you.  You want to insure the fact your house isn't gonna burn down, they're gonna make a bet that it will, you make a bet that it won't, here's the negotiate price.  Life insurance, same way.  You pay the premium, everything's adjusted in their favor, obviously, they hold the cards, and then they take all these premiums and they run out and make investments in it. 

This is what got AIG in trouble.  Hank Greenberg, the guy that ran that, came up with some of the most creative ways for AIG -- they weren't -- they sold insurance but what they were actually doing with the premiums collected, it was all legal, but it really ticked off Eliot Spitzer, because it was too creative so he became a target, Greenberg did. But they take all this premium money, and they invest it and they try to grow it all kinds of ways, and they don't like to pay out, quite honestly.  They do in certain circumstances for PR purposes, you have a natural disaster, tornado, they're really right in there paying off, but they're just making bets with you.  What's happening here is they're now being told because of this law that there is no limit on what they are going to have to pay.  They can't stay in business, nobody could, which is the ultimate aim of this.  

BREAK TRANSCRIPT

RUSH:  I don't.  I don't have a cap on anything.  I don't know what a cap is.  I mean, of course I know what a cap is.  In this case I didn't know who was capping what and why.  And I had to just figure it out, and I did. But out of pocket expenses, everything's an out-of-pocket expense for me, but I have deductibles too.  I mean, look, a deductible on my home.  You know what the deductible is on wind coverage here?  Hurricane?  It's like a million dollars.  It's stupid, they don't want you to buy it.  Million-dollar deductible.  I know what that is.  You have deductibles on the automobiles and stuff.  But I never make a claim.  And isn't it interesting, the rates still go up.  I never make a claim.  Never. 

Everything I pay out-of-pocket, whatever, bubble gum, I don't eat bubble gum.  Nobody gives me anything, is the point.  I don't get subsidized on anything.  I don't want to be, don't misunderstand, I'm not crying over spilt milk here.  I wouldn't want to have to keep up with it.  When you are being subsidized, what are you doing?  You're spending all your time trying to figure out whether you're getting screwed or not. 

END TRANSCRIPT

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