Thanks to Chief Justice John Roberts, the Affordable Care Act (ACA) is the law of the land. Interestingly, like the 18th Amendment to the Constitution prohibiting alcohol and 1919's Volstead Act enforcing it, what is sometimes derisively called Obamacare may end up once again proving the law of unintended consequences. Much as how the Anti-Saloon League was triumphant and confident in their victory over booze in America, only to discover they had loosened the forces of organized crime, heavy drinking and a libidinous cocktail culture, so too Democrats may discover that avoidance of the ACA may become a prevalent art form and Republicans may find that blind opposition to it may become a giant sand trap.
The first way around the law for an employer (whether in the public or private sector) is to get a waiver from the Administration delaying or altering implementation of the provisions of the law, as have more than 1,000 unions and businesses so far to date. Waivers may start to be issued at the frenzied face of Papal dispensations and indulgences during the Middle Ages. This will create yawning holes in the perceived fairness of the act as some groups with access and influence will avoid having to participate for a time. This will encourage business, unions and individuals to look for their own ways around the act if they can't secure a coveted waiver.
Let's look at individuals first -- Henry Blodget at Business Insider wrote that many Americans "seem to hate the idea that Obama is forcing them to do something more than they hate the idea of shelling out money." Which doesn't mean that the money doesn't matter. The Supreme Court has ruled that Congress can penalize you in the form of taxation for not buying health insurance if you're not getting coverage now at work. These "penalty taxes" will be phased-in between 2014 and 2016. The minimum penalty will be a mere $95 per person in 2014 for people earning between $9,500 and $37,000 a year. Under $9,500 you're exempt. This escalates to a maximum of $695 per person by 2016 and for families, the maximum you can be charged is three times the $695 if family income is below $40,000.
Above $40,000 there is a 2.5 percent penalty tax on household income, which at $50,000 would be a $1,000 tax; $1,600 on $75,000 and $2,250 on $100,000. The penalties max-out at $200,000 where the tax would equal the cost of a "Bronze Health Insurance Plan" offered by the state insurance exchanges, or an estimated $5,000 for individuals or up to $12,500 for a family. The rub here on avoidance for individuals is that high income folks generally have health insurance now and will continue to do so regardless of the law. While the intent of the law is to insure millions of currently uninsured young people and middle class workers, it is precisely these young people who may be more inclined to pay the $695 annual tax if they're making $35,000 and forgo health insurance costing $400 to $500 a month of their net income. In fact, in an expensive place like New York, it is wholly conceivable that young people (the very folks needed to minimize risk for insuring older Americans) even grossing $60,000 or $80,000 might find it more cost effective to give $1,500 to the government rather than pay $6,000 or more for insurance coverage. More young and moderate income people may opt to pay the penalty and forego the insurance -- the exact opposite of the ACA's intended goal. If you avoid even paying the tax, the IRS has no sharp teeth here, they can only sue you, not seize your assets and the maximum they can collect is just twice the amount you owe. Easy to imagine here that a lot of people will thumb their noses at even paying the penalty. You'll also see more people claim Native American ancestry as members of Indian tribes and even the Amish are exempt entirely. Can a Christian Scientist exemption be far off? The state insurance exchanges and the insurance companies could be somewhat hobbled by the ACA's prohibition on charging older folks more and younger people less along with young people deciding to pay the tax instead of signing up.
For companies the formula is a little different. Businesses with fewer than 50 full-time employees are exempt from being required to provide insurance. The ACA defines 'full-time" as 30 hours a week or more. Failure to offer insurance will result in a $2,000 per-employee fine, but the first 30 employees are exempt, so a company with 50 full-timers would have to pay a $40,000 penalty on the next 20 uninsured workers. When this is compared to having to pay between $5,000 and $15,000 to cover all their 50 workers, many businesses may opt to just pay the tax as a way to save money without a shred of guilt because their workers would then be eligible for low-cost coverage in the ACA's insurance exchanges. Ironically, businesses not providing insurance who may have some employees receiving low-income subsidized coverage in the exchanges, will be taxed $3,000 per employee. This could cause some businesses to avoid hiring lower income applicants to keep their overall penalties lower.
The Labor Department reported that 80,000 new jobs were created last month, of that figure, 25,200 were temporary jobs. According to Economist David Rosenberg, businesses are moving to "just-in-time" hiring strategies that revolve around an increasing use and dependence on temp workers. Temps are outpacing full-time hires by 10 to 1 in many companies. Manpower Services (a temp worker agency) said that only 30 percent of their workers landed full-time jobs this year. Companies will hire more people on part-time shifts to avoid hitting the 50 full-time employee threshold along with temps who work for just a few weeks. Some small companies will just opt to stay small instead of looking to expand so as to avoid increased mandates and penalties. Seasonal businesses will be penalized for aggregations of part-time employees working under 30 hours a week who will then be added-up to count as one full-timer. Some businesses will start subcontracting ("outsourcing") a great deal of their lower end labor needs to independent labor providers, like the character Johnny Gallagher provided Scarlett O'Hara for her lumber mill in Gone With The Wind. Look for a profusion of 25 employee businesses providing per-project work for other businesses and that may run the gamut from bussing dishes, deliveries to bookkeeping. There will be a lot of musical chair-rotating temps and outside independent contractors.
For Republicans, sticking their heads in the sand is not an answer -- voters will be looking for some kind of health plan, not just "repeal everything," which would be like saying that Social Security and Medicare should be repealed, which is a non-starter for most voters. The GOP and Mitt Romney need to do some creative thinking and offer an alterative that is socially conscious (as opposed to unconscious) and fiscally responsible while not being a disincentive to business expansion.
A step in that direction is what I've previously called "Americare," in which all Americans get basic catastrophic coverage with premiums deducted from their paychecks (since Congress can now tax for this) and then the private sector can offer extra coverage options above the national base, much as insurance companies do now with seniors for expenses above Medicare Part B coverage. The extra coverage ought to be available across state lines and portable nationally and irrespective of employment or the place thereof. Competition would bring prices down and mandatory basic coverage for every American will spread risk and protect hospitals. Because of "Americare," taxes and penalties could be lifted from individuals and businesses, thereby reducing the size of government. But offering Americans absolutely nothing but "repeal" is no way for the GOP to attract independent swing voters or do something positive for the American people.
Stephanie Schriock: It Will Be the Best of Times
Kenneth Davis and Wayne E. Keathley: The Affordable Care Act, Practically Speaking
And thus the problem with repeal and replace. Even a thoughtful, reasonable, non-idealogical analysis of the healthcare systems agrees we need to do SOMETHING, like you have. The status quo is NOT acceptable. If you repeal ObamaCare, there MUST be a replacement, and GOPs haven't come up with anything even remotely close to a replacement in 18 months since taking over the House.
This "replacement" you have come up with sounds VERY reasonable, and pre-ObamaCare, GOPs would've considered it. ******OBAMA WOULD'VE CONSIDERED IT****** He would've considered anything. The most contradictory criticism of Obama during the ObamaCare WAR was that he was both being idealogical:demanding a specific bill, but just wanting to pass anything. The latter criticism was probably accurate. He WOULD'VE PASSED ANY BILL THAT WAS LABELED HEALTH CARE REFORM that landed on his desk: 2000pages or 20 pages. He would've signed Wyden-Bennnett....heck he probably would've signed Wyden-Ryan. Obama understands the long-term legacy value in this victory. The GOP has made the value so great by fighting it so hard, like civil rights.
I don't think that the neocon's Ryan plan begins to cover any more people, and will eliminate poorer people who are covered by Medicaid from healthcare coverage altogether, while giving several trillion dollar a year in tax cuts to millionaires...and making the Bush tax cuts permanent. The huge gains for the rich will be at the expense of the working and middle class.
ACA will be put into effect, covering more people, and the bugs can be worked out of it as we go along...that's the beauty of having something rather than nothing.
By requiring us to purchase the services of the people who caused the problem, the problem has been extended.
Plus, to retain the word “Affordable” in the ACA, health care reimbursements by Medicare, mandated by Medicare Law, must decrease by 27%. Should that happen to keep costs in line, good luck finding a Medicare provider. Providers will flee Medicare like rats deserting a sinking ship. It is already happening.
Insurance, whatever the source, is only useful if one has physician access. If you are one of the newly enrolled, and expect to find a GP, you should probably brush up on your Hindi.
Your doomsday scenario would require that the 30 million new insured have never seen a doctor before they got insurance. In fact they now go to emergency rooms when they get sick and see doctors. Under the new system, some of those will see doctors sooner so their illnesses will be less complicated, and they will require less medical care.
Also, there are quite a few very good doctors in our system now who may come from different countries. Most of them speak English.
i know there are excellent foreign trained physicians. Personally, I select my physicians based upon training and experience. That is very hard to judge on paper for foreign graduates.
Finally, it is not doomsday. It just means that waits will be a lot longer. The doomsday comes if physicians stop taking Medicare and Medicade patients. None of my Drs now take new medicare patients. I recently needed minor oral surgery. We have 14 providers in my area. One takes Medicare. The wait to see him was months. I just paid and it was done in 10 days. I teach medical school. If you don't think these issues are are of major concern, you are talking to the wrong people.
As an example, while the principle stays the same (irrespective of its merits) the current Catastrophic Health Insurance is quite different from when the plans / coverage was introduced more than 10 years ago.
So bloggers, rather that argue endlessly about healthcare and ACA, please impress on your congressman and senators, irrespective of party affiliation, to move forward with some action and compromise.
Healthcare is not politics. It is access (to healthcare), quality and cost.
Those to do not want to address these issues or are ignorant about them, politicize healthcare (what ever that means) for their own agenda. We the electorate should not become pawns in their game and should not fall for their sloganeering.
Healthcare is not sound-bytes like "death panels" or "pushing grandma over the cliff."
The current healthcare system is NOT sustainable. Neither is the current never-ending arguments and politicization of how we solve our country's pressing problems. Politicians only seek to spin the issues to keep the controversy alive to get campaign contributions and votes.
The republicans are out to ruin this country over their belief that if I can't have it, no one else should similar to crying little girls
They talk about market based solution. Like it has been government based solution.
Their favorite solution is tort reform, like is going to save the insurance industry.
While their vote is purely symbolic because Democrats in the Senate will stop it, the American people deserve to know what is specifically at stake for them and their loved ones if the Republicans get their way.
If the health care law were to be repealed, we would return to the dangerous system we had with people kicked off their insurance when they got sick and families driven into poverty by soaring premiums and health care costs.
More than 6 million young adults would no longer be guaranteed that they can stay on their parent's plan until they are 26. Why would anyone want to repeal that?
Five million seniors across the country would no longer get help with their prescription drug costs. If the Republicans get their way, many of these seniors will return to choosing between taking their prescription drugs or eating dinner.
If the Republicans repeal health care, there are 105 million Americans who will once again face lifetime limits on the care they can get from their health insurance plans.
Mitt Romney boasts that he will repeal health care reform on his first day in office. So people really need to be reminded which party will hurt them from day