NCPA president John Goodman explains how Obama uses his magic pen here:

Did you know that when the president signed the Patient Protection and
Affordable Care Act (PPACA) he wiped out $53 trillion of unfunded U.S.
government liability? With the stroke of a pen, more than 60% of
Medicare?s long-term deficit vanished? Poof. Zip. Gone. 

Goodman concludes:

There is no more effective cost control device in the world than the
simple expedient of denying people care. And that is what is being
forecast for the future of the elderly and the disabled.

P.S. We rarely get partisan at this blog, but in this case I think
we can safely say that it?s too bad the PPACA was not a Republican
bill. If it were, everything you are reading here would be front page
and above-the-fold in the East Coast press.