1. The Bill mandates that a lawful resident of the United States must purchase Healthcare Insurance as a condition of that residency. This is an individual mandate possessing two features that, in combination, would make it unique and unconstitutional.
1. First, it would impose a duty on individuals as members of society.
2. Second, it would require people to purchase a specific service that would be heavily regulated by the federal government.
2. An individual mandate to enter into a contract with or buy a particular product from a private party, with tax penalties to enforce it, is unprecedented-- not just in scope but in kind--and unconstitutional as a matter of first principles and under any reasonable reading of judicial precedents.2
3.  First, most arguments, either favoring or opposing the individual mandate, do not discuss the Supreme Court's "class of activities" test, which it has applied in every relevant Commerce Clause case. 2
4. Second, the common but mistaken position used by the Bill’s supporters, suggests that a universal federal mandate to obtain health insurance is no different than a state requiring its licensed automobile drivers to have liability insurance for their injuries to others.2 This is blatantly false. 
5. Third, this paper analyzes claims arising under the Taxing Clause. A preliminary review raises serious questions about the constitutionality of using the taxing power in this manner. 2
6. Finally, it is highly unlikely that the Supreme Court would break new constitutional ground to save this unpopular personal mandate.2

Footnote 2: Hat tip to The Heritage Foundation from http://www.heritage.org/Research/LegalIssues/lm0049.cfm

1. The “takeover” specified in the Bill is not permitted by the U.S. Constitution
2. The Bill creates a new minimum federal standard benefit package
3. The Bill establishes a new Health Benefits Advisory Committee that will regulate the care administered by all plans.
4. The Bill limits age rating between older and younger to 2:1 (respectively) when costs incurred by plans are approximately 5:1 (respectively).
5. The Bill delegates rate setting authority to the Office of Health and Human Services (HHS) and requires them to approve rate increases.

1. Establishes a 5.4% “surtax” tax on incomes in excess of $500,000 single and $1Million joint not indexed to inflation.
2. Establishes an excise tax on the first taxable sale of medical devices equal to 2.5% of the sales price.
3. Requires that employers providing Health Insurance coverage for their employee pay 72.5% or more of the cost of the lowest individual employee health insurance and 65% of the lowest family health insurance cost.
4. Requires that the employer contribute a percentage (up to 8% depending upon gross wages) of the average wage paid during the employee’s enrollment to the Health Insurance Exchange Trust Fund for each employee who declines employer based coverage (enters the Health Insurance Exchange) or for whom no health insurance is offered.  
5. The Bill allows the Secretary of Health & Human Services (HHS) to asses a $100 fine for each day an employer purposefully fails to provide health coverage.  
6. Requires individuals to report the names, addresses, and taxpayer identification numbers of each individual covered under the taxpayer's health care policy, and the length of time each individual is covered.
7. The Bill increases the penalty for a non-qualified withdrawal from an individual's health savings account (to 20 percent from 10%).

1. The Congressional Budget Office (CBO) estimates that the Bill will cost 1.05 Trillion with certain offsets that bring the cost down to $900 billion. However the CBO did not “score: or account for many provisions that are in the bill that are conservatively estimated to increase the cost by $217 million to a total cost of $1.3 trillion. Because benefits do not begin until 2014 (fifth year) and most taxes begin immediately, the true cost for the first ten full years of benefits under the bill are a whopping $2.4 trillion.
2. The Liberal-Led Democratic Congressional Leaders have elect to place the so-called “Doc Fix”, that will cost an additional $200 billion, in a separate bucket of funds and not “score” it will the rest of the bill to keep under the $900 billion price tag set by President Obama. 

1. The Bill offers generous taxpayer subsidizes to individuals and families with income up to 400% of the Federal Poverty Level (100% of the FPL=$22,050 in 2009 for a family of four) for coverage purchased through the New Health Exchange, not private plans. 
2. The Bill offers additional cost-sharing subsidies for individuals and families below 350% the FPL to cover out-of-pocket costs but only for coverage purchased through the New Health Exchange, not private plans.   
3. Example: A family of four, covered by the Health Exchange Plan, with income of $66,150 (300% of the FPL) and basic coverage would have an average premium of $15,000 but receive subsidies of $10,500(consisting of $8,700 for premium and $1,800 for cost sharing), thereby bringing the net cost to $4,500. The same facts except under an employer sponsored plan would receive no subsidies. 
4. Subsidies are also prohibited if the individuals are Medicaid eligible (currently there are 60 million persons who are covered by Medicaid). Thereby creating a third class of healthcare (Private, Federal Sponsored and State Sponsored), with State Sponsored persons receiving the lowest level of care. Related to this is the requirement that States freeze Medicaid eligibility at current levels.   

1. An income surtax on taxpayers earning more than $500,000 a year
2. An excise tax on high-cost "Cadillac" health insurance plans that cost more than $8,500 a year for individuals or $23,000 for families
3. An excise tax on medical devices such as wheelchairs, breast pumps, and syringes used by diabetics for insulin injections.
4. A cap on the exclusion of employer-provided health insurance without offsetting tax cuts.
5. A limit on itemized deductions for taxpayers with a top income tax rate greater than 28 percent.
6. A windfall profits tax on health insurance companies.
7. A value-added tax, which would tax the value added to a product at each stage of production.
8. An increase in the Medicare portion of the payroll tax to 3.4 percent for incomes great than $200,000 a year ($250,000 for married filers).
9. An excise tax on sugar-sweetened beverages including non-diet soda and sports drinks.
10. Higher taxes on alcoholic beverages including beer, wine, and spirits.
11. A tax on individuals without acceptable health care coverage of up to 2.5 percent of their adjusted gross income.
12. A limit on contributions to health savings accounts.
13. An 8 percent tax on all wages paid by employers that do not provide their employees health insurance that satisfies the requirements defined by the Secretary of Health and Human Services.
14. A limit on contributions to flexible spending arrangements.
15. Elimination of the deduction for expenses associated with Medicare Part D subsidies.
16. An increase in taxes on international businesses.
17. Elimination of the tax credits paper companies take for biofuels they create in their production process--the so-called "Black Liquor credit.
18. Fees on insured and self-insured health plans
19. A limit or repeal of the itemized deduction for medical expenses.
20. A limit on the Qualified Medical Expense definition.
21. An increase in the payroll taxes on students.
22. An extension of the Medicare payroll tax to all state and local government employees.
23. An increase in taxes on hospitals.
24. An increase in the estate tax.
25. Increased efforts to close the mythical "tax gap.
26. A 5 percent tax on cosmetic surgery and similar procedures such as Botox treatments, tummy tucks, and face lifts.
27. A tax on drug companies.
28. An increase in the corporate tax on providers of health insurance.
29. A $500,000 deduction limitation for the compensation paid by health insurance companies to their officers, employees, and directors.

Footnote 1: This list is taken from The Heritage Foundation at the link: http://www.heritage.org/Research/HealthCare/wm2706.cfm

1. Illegal immigrants are not excluded from participating in the health insurance exchange. There is NO requirement that lim­its plan participation to citizens and/or lawful residents.
2. Illegal immigrants would be benefit from the public option. There are no restrictions on illegal immigrants participating in the plan either as employees or as individuals. Congress will likely have to pro­vide the "public option" health care plan with seed money and subsidies in the future.
3. Illegal immigrants would not legally be eligible for affordability credits, but verification is so weak that they can easily be covered by fraud and deception.
4. Section 305(d) of the Bill provides Medicaid coverage to all newborn children who do not have other insurance coverage, without regard to the family’s income. No attempt will be made to have the mother repay the costs [in the last year almost 400,000 children were born in the United States to illegal women]. Therefore, the Bill seems to create incentives for even greater illegal immigration in the future.   

Footnote 3: This list is taken from The Heritage Foundation at http://www.heritage.org/Research/HealthCare/bg2345.cfm