2013-05-31 / View From Here


As health care reform approaches

For better or worse, President Obama’s health care reform legislation, sometimes called Obamacare, is scheduled to take virtually full effect in the beginning of 2014. Whether or not this transition will produce a “train wreck”, as predicted by one Democratic senator, it is certainly fraught with uncertain consequences.

As an article in The New York Times last weekend pointed out, almost everyone believes that the bill is flawed, but there is virtually no possibility of legislative amendments that will improve the situation, as occurred with other major new laws. This is because most Republicans in Congress are dead set in favor of outright repeal of a law passed with virtually no support from their party, while Democrats do not desire to reopen a charged debate.

So implementation of the law, which remains quite unpopular with the public, is moving forward. Thousands of pages of regulations have been issued, many by the suddenly controversial Internal Revenue Service, which will have jurisdiction over new excise taxes, including one imposing “shared responsibility” on larger employees to provide health care coverage for employees by imposing a per head tax for noncompliance. Health care exchanges are being constructed in those states that have opted to have them, although many states have refused, with the federal government required to provide the exchanges. An application form, originally 21 pages, has been pared back. A few problems have already manifested themselves. While the legislation attempted to address lack of coverage among low income groups by requiring states to expand Medicaid eligibility, the Supreme Court struck down that portion of the law and many states have declined to widen their Medicaid rolls, thus undermining a key component of the design. There are reports of employers limiting employees to 29 hours a week to avoid coverage of “full time” employees. Workers at small business will have to wait a year before having a choice of health care plans. A major strategy of the law has been to encourage healthy young people to sign up for health insurance to keep rates low for other population groups, but money for a publicity campaign has not been appropriated. Some large employers are contemplating gaming the system by offering only bare bones coverage that covers preventive care only.

Probably the biggest concern about the new law is the possibility of very large premium increases. The Society of Actuaries roiled the debate over health reform with a study predicting that average premiums in the individual market will rise on average about 32 percent under health care reform, which presumably would discourage many people not covered by employer sponsored insurance from obtaining or retaining coverage. It remains to be seen if there will be major increases in the employer sponsored market as well. Even now, a number of relatively generous plans are cutting back benefits such as low deductibles for fear of later being subject to the new law’s “Cadillac tax” provisions.

It is probably a bit of a longshot, but, short of repeal of the new law, which would never be accepted by President Obama, some sort of delay in the implementation of the law would seem the next best approach. During the hiatus, an evenly balanced bipartisan committee could review the law’s provisions and make recommendations. The present solution, pressing ahead with a massive law that is generally conceded to have problems, isn’t likely to be pretty. NOTICE YOU HAVE A HIDDEN TALENT… …that has yet to be discovered in print? We are looking for articles, not exceeding 3,000 words or less than 1,500 words, on local topics, opinions, ideas, nice places to visit on Long Island, and even fiction. In our magazine section, we will try to: “Discover” one new feature length article and writer per week. Each writer will be reimbursed a stipend of $25.00.

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