About two thirds, or one trillion dollars over the next decade, is money out of the government treasury. The rest is from major sources of revenue and program cuts. From TNR:
Cuts to Medicare providers, much of it in the form of a “productivity adjustment” that will result in hospitals receiving lower reimbursements … $415 billion
Higher taxes on the wealthy, via a higher Medicare payroll tax on individuals with incomes above $200,000 and families with incomes above $250,000 … $318 billion
Fees on the health care industry, including fees on drug and device makers … $165 billion
Penalties, from individuals who could get affordable insurance but don’t, and from medium- and large- employers who don’t fulfill the requirement to offer coverage … $161 billion
Reduced payments to private health insurers offering coverage to seniors through the Medicare Advantage program … $156 billion
The “Cadillac tax,” which starting in 2016 will reduce the existing tax break for the most expensive health plans … $111 billion
And one obvious takeaway is that the majority of funding in the law is money paid by—or given up by—either the wealthy or parts of the health care industry. It’s higher taxes on families making more than $250,000 a year, or new fees for the device industry, or cuts for health insurers serving Medicare patients. The exceptions are two of the smaller categories of spending, the penalties and the Cadillac tax. Some of that burden will fall on middle class people. But only some.The article summarizes the redistribution neatly:
The health care industry in general, and hospitals in particular, are re-engineering themselves so that they can do more with less—although experts disagree about how real or long-lasting the effect will be.
As for the cuts to Medicare Advantage insurers, those have been long overdue for their own sake. A series of private and public assessments, including studies by the Congressional Budget Office and General Accounting Office, suggested the government had been overpaying insurers by large margins. In other words, it had become a form of corporate welfare.
The simplest way to describe Obamacare is as a transfer from the lucky to the unlucky. And when it comes to health, you don't have to be poor to be unlucky.