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I was surprised to learn that Chief Justice Roberts joined with 4 others in a majority opinion that the act would pass constitutional muster. Some of my previous messages were about my belief that the law would be declared unconstitutional on grounds that it violated the First Amendment of the U.S. Constitution clause about freedom of speech. The case of United States v. United Foods, about the section of the 1990 farm law known as the Mushroom Promotion, Research, and Consumer Information Act, declared to be unconstitutional for violating the First Amendment was my bet as to the part to be used.
Remember the word “tax”. I believe that legislation adjusting provisions of the income tax laws get more attention in Congress than any other type of law except for the annual appropriations laws. I think that the tax provisions of the Affordable Care Act will be made to become so cumbersome and complicated that medical service providers will begin to opt out of providing service to minimize the need to include this in their income tax returns.
It may become like the Foreign Tax Credit provisions IRS Form 1116 for taxes paid to foreign countries on dividends and capital gains of foreign stocks. It costs me money to have my accountant do the complicated calculations to reduce my federal income tax by some small amount. Another possibility is that medical service providers will reincorporate themselves in ways that allow them to pass on the costs of complying with federal laws and regulations to the patients and to their insurers. Instead of declining to see patients whose medical insurance coverage is medicare or medicaid, medical service providers will find ways to discourage patients because the additional income tax return burden on the patient will encourage them to seek help elsewhere. Or, it may cause insurers and self-insurers to say, “you have to pay extra if you go to X for service”. A bill for medical service will begin to look like the charges for having a bank account, or flying on an airplane.
I am sure that there are some ambitious people out there working on seminars of this type: How to Increase Your Practice Revenue through the Affordable Care Act.