Okay, I'm one of those evil, "fear-mongering" Republicans that you read about who are worried about Obamacare.
Worse, I'm a Republican business owner who's also a Certified Public Accountant. Ugh! But please don't hate me. I like puppies. Really, I do! I think Barbra Streisand is a great singer and Rachel Maddow is really smart (and kind of cute too). I went to an Earth Day event back in 2010 and I even wore sandals. Okay, I admit that I own a gun, but it's only a Taser, so that really doesn't count right? I'm writing this to tell you that all Republicans aren't evil, especially business owners. And we're not trying to scare you about health care reform. Well... maybe a little.
Health care reform is based on this assumption: there are currently 30 to 46 million uninsured Americans. By requiring them to purchase health insurance this will open up a huge market for the health insurance industry. So, in return for this enormous, new revenue stream, the government is requiring the industry to provide more coverage so that everyone can have health care. Can anyone, even a cold-hearted, emotionless, evil Republican deny that providing decent, affordable health care for everyone is something a great society for ours should be doing? Of course not.
And really... no one should be "scared" about health care reform. But there are some scary things about this legislation. And the scariest things have to do with cost. So, c'mon... put on your Darth Vader mask, crank up some Nugent and take a wild ride in this evil Republican's pickup truck as I share some of the scarier things about Obamacare... from a business person's standpoint.
Scary Thing #1: Many part-time workers who were getting coverage may find themselves without coverage going forward. The way the law works, if you're an employer with more than fifty full-time equivalent employees (it's a calculation that combines all full-time and part-time employees), then you have to provide health insurance. But only to your full-time people (those working more than 30 hours per week). If an employee works less than 30 hours per week, than you are under no obligation to provide health insurance -- which is why companies like Walmart and others who hire lots of part-time workers have instructed their security guards to shoot on-site anyone working more than 30 hours per week. Okay, just kidding about that. But larger companies are increasing their part-timers and decreasing their full-timers so they can minimize the number of people they are required to cover by law. If you're a part-time person working two or three jobs you may very well have to find (and pay for) your own health insurance. And remember... you're now required by law to do this.
Scary Thing #2: Doctors could get crushed, and their quality of work may be significantly impacted. The legislation will require much more paperwork for doctors and hospitals. It will require more oversight by the government. It is forcing upon them electronic records. It will (hopefully) introduce millions of more patients into a system that's already busting at the seams. And many of these patients will be covered by Medicare or Medicaid which mean lower reimbursements for services. I'm not saying this is a bad thing, but many doctors I know, particularly those running their own practices, aren't equipped to handle all this. A few I know are thinking of dropping out of the system all together and contracting out their services directly to people that are willing to pay them directly. The remainder that stay will be forced to handle more people more frequently and make more decisions in less time in order to generate enough volume to make it all worthwhile. It's becoming less and less desirable to go into that profession.
Scary Thing #3: If costs continue to unexpectedly rise, taxpayers are going to feel it. When first introduced in 2010, the Congressional Budget Office estimated that the Affordable Care Act would reduce our deficit by $140 billion over the next ten years. But unfortunately, the costs keep rising. Just recently, the Wall Street Journal reported that the Department of Health and Human Services, tasked with implementing the exchanges where we would buy our insurance, "burned through" all the dollars ($5.9 billion) appropriated for the implementation. Needing $2 billion more, the department is reportedly drawing out dollars from a $5 billion "Prevention Fund" which reportedly has no accountability. Wow, talk about an overrun... and we haven't even started yet. There are other huge unknowns, like the cost of Medicare and other reimbursements. The biggest fear that the evil Republican business people have about this legislation is that the costs were not fully considered before it was signed into law, which is not the way that we make our investments. If these estimates are significantly out of whack and throws our deficits further into the red it will be taxpayers who will have to pick up the pieces, if not soon then in a few years down the road.
Scary Thing #4: Business people are REALLY afraid that premiums will go up a lot. It's because of that 34 million uninsured thing. No one knows for sure how many of these guys will buy health insurance come January 1st. And what if they don't? There aren't enough auditors to track them down. And even if you do track them down, do they even have the money? And if a sick person without insurance shows up at a hospital for treatment will hospitals now turn them away? I don't see that happening. So if that giant market promised to the insurance industry doesn't materialize and the insurance industry has been forced to provide all sorts of new benefits (like dependent care, pre-existing conditions, etc.) who's going to pay for those additional costs? Most of my clients haven't received their premium bills for 2014 yet...and they are really scared. Not to mention the potential for big increases in 2015 and beyond. Can you blame them? And what will they do? They will likely ask their employees to share in these costs. Which means that...
Scary Thing #5: ...full-time workers may find themselves paying a lot more for their health insurance. Starting next year companies will choose from "bronze," "silver," "gold" and "platinum" plans. (Certain evil Republicans may be offered a "kryptonite" option too, but this is still under consideration.) These plans will all offer the same coverage but will have different levels of cost. For example, the "gold" plan will have lower deductibles than a "bronze" plan so premiums will be higher. The minimum required by the law is the "bronze" plan. If premium costs rise, many employers will likely continue to offer the legal minimum but if an employee wants a plan with the same deductibles as now then he or she will have the option of paying for a better plan... which will cost them more.
Oh, and here's a Bonus Scary Thing: There's still no requirement for insurance companies to cover male pattern baldness. Really? Contraceptives are covered but I can't get a little help buying some Rogaine? Curse you Democrats with your full heads of hair! This country needs more evil Republicans like me in power.
A version of this article originally appeared on The Philly Post.