Tag: individual mandate

Fixing the ACA or Obamacare makes more sense than repeal

Fixing the ACA or Obamacare makes more sense than repeal

Posted on by Jack

It seems that ever since the Affordable Care Act (aka ACA or Obamacare) was passed and then passed muster in court, nearly all Republicans have wanted it repealed. The latest efforts involve shutting down the government as we enter a new fiscal year and refusing to raise the debt ceiling so the government defaults on its debts.

Both efforts seem foolish and I have discussed them recently.

I live in Pennsylvania and get emails from Senator Toomey. He discussed his desire to compromise on the government shut-down stand-off by adding 3 amendments to the Senate bill. These amendments did not make it into the Senate bill. I do not think the debate on Obamacare should be part of the government shut-down or debt ceiling debates but these are good discussion points on the law.

The first would repeal the medical device tax that is costing Pennsylvania jobs; the second would provide relief from the infringement on religious liberty in Obamacare; the third would delay the individual mandate for one year.

I probably would back the repeal of the medical device tax. It seems to me the best way to do this would be a a separate bill but now seems a bit rushed. I don’t see much benefit to this tax since I would assume the tax would just be passed along as part of the cost of health care. So there is really no benefit since the users of heath care pay the tax and there well could be a job loss associated with this. But on the other hand with more people insured and using health care there may not be a job loss. I’d like to see more discussion on this point.

Regarding the second suggestion (infringement on religious liberty), I think this is inevitable as long as we insist on standards in health insurance. I think the employer mandate is problematic. The religious objection of an employer may or may not seem reasonable to others. One person may object to contraception and another may object to this or that aspect of health care. A public option would be much simpler here but I don’t think that is what the Senator had in mind.

As to the third point (a 1 year delay), there may be a problem. I assume the insurance companies took the widened risk-pool provided by the mandate into account when setting the rates for 2014. If this is not the case and we do not have additional delays such as a 1 year delay every year, it might be worth discussing this.

The ACA is a complex law with many parts. There are things I like and things I don’t. There seem to be things we could fix now and problems that would not be apparent until parts of the law are implemented. And we certainly could use a reasonable discussion of the pros and cons of parts of this law.

Rather than have a series of political stand-offs to attempt to repeal the law, maybe Congress could work to improve the law.

Is Obamacare and employer-provided insurance pro-business or anti-business?

Is Obamacare and employer-provided insurance pro-business or anti-business?

Posted on by Jack

The Patient Protection and Affordable Care Act of 2010 (PPACA), commonly called the Affordable Care Act (ACA) or Obamacare, is controversial. Republicans consider it anti-business; Democrats not so much. But is it really more pro-business or anti-business than our present system ?

Employer-provided health insurance began during World War II as a way of getting around wage controls on businesses. Currently most of the insured under 65 have employer-provided insurance. Obamacare is similarly dependent on employer-provided insurance. Sort of a doubling down on the idea by mandating that employers provide insurance or pay a penalty.

But is employer-provided insurance a good thing? Or would we be better off if the insurance was provided by another method ? And how do we pay for it ?

So many questions. Are there good answers? What do you think?

Implement and Improve the Affordable Care Act (ACA)

Implement and Improve the Affordable Care Act (ACA)

Posted on by Jack

Now that the election is over and Democrats remain in control of the Senate and President Obama occupies the Whitehouse, it should be clear to everyone that repeal of the Affordable Care Act (ACA) is extremely unlikely and House Republicans can stop wasting their time with this repeal and replace nonsense for at least the next 4 years.

There are many good things about the law. Or at least I think it is good that insurance companies cannot exclude people who they think will be expensive because of preexisting conditions. I think it is good that they cannot cap the benefits someone who gets seriously sick can receive. But I do not believe the law is perfect.

There are also a good number of things that do not seem like great ideas. And people will differ in opinions as to what those are. For example, many oppose the individual mandate to have health insurance. Others may think the free rider provision for employers is not such a great idea.

You can disagree with some provisions of the law without disliking all of it.

But the ACA is law and there is almost no chance of that changing. I see lots of good things but there are also problems, or at least provisions that some people see as problems. Unless you are happy with all of it, actively encourage your Representatives, Senators, and President to improve the ACA.

Plan B alternative to the individual mandate for health insurance

Plan B alternative to the individual mandate for health insurance

Posted on by Jack

Last month I wrote about Plan B or finding an alternative to the individual mandate for health insurance . Several have been proposed but I’d like to point out a recent NY Times opinion piece by Ross Douthat which says in part:

The mandate is a harder puzzle, since it works in tandem with the requirement — popular enough to have many Republican supporters — that insurers cease denying coverage to customers with pre-existing conditions. If you repealed the mandate without repealing that requirement, people could simply wait until they were sick to buy insurance, driving everyone’s prices up.

But Republicans could propose dealing with the same problem in a less coercive way. One alternative would establish limited enrollment periods (every two years, for instance) when people with pre-existing conditions could buy into the new exchanges without being denied coverage. Anyone who failed to take advantage wouldn’t be able to get coverage for a pre-existing condition until the next enrollment period arrived. This would reduce the incentive to game the system, without directly penalizing Americans who decline to buy insurance.

Several other ideas for conservative reforms of the health care reform known as ObamaCare are discussed and the article is worth reading but this seemed directly relevant to my thoughts on finding alternatives to the individual mandate for health insurance.

Health care reform: Plan B for individual mandate

Health care reform: Plan B for individual mandate

Posted on by Jack

Yesterday I wrote about Plan B for the individual mandate which could be threatened by court decisions or a future congress. Health care reform ensures that insurance companies must take people with preexisting conditions. The obvious problem is that someone could skip having insurance until they know big medical bills are coming soon and then apply for insurance and companies would be powerless to refuse and so be stuck with pick payouts for relatively little in premiums. The solution in the Affordable Care Act (aka ObamaCare) is the individual mandate .

A few days ago there was a court decision that ruled the individual mandate unconstitutional (see Bloomberg News story). There will be more litigation and the issue may end up in the Supreme Court.

Striking down the individual mandate by the courts or perhaps a repeal of this provision would be bad news for heath care reform but it is good to see that someone is thinking about a Plan B (see Kaiser Health News story)just in case the individual mandate is out of the picture.

The most straight forward idea would just be to raise taxes enough to cover insurance cost for the whole country and then offer a tax rebate to each filer that would cover a reasonable insurance plan and have some sort of mechanism for insuring those who cannot afford to pay full price for a reasonable plan. This approach would probably be a hard sell in an age of “no new taxes”.

But other options are surely possible. I like the one suggest by Paul Starr of Princeton in the article cited above (Kaiser Health News). Perhaps this or some variant of the idea might be useful.

Princeton sociologist Paul Starr, who was a senior health adviser to President Bill Clinton, anticipated the risk of political backlash even before health law was passed. He outlined a more flexible alternative aimed at quelling political fires while still expanding the insurance pool.

Except for the poor (people making less than $9,350 and couples earning less than $18,700 are not subject to the mandate but would be eligible for coverage under Medicaid), people would have three choices, Starr said. They could buy insurance, with subsidies if they qualify. They could pay an annual tax penalty for going uninsured. Or they could opt out with no penalty – but they couldn’t opt back in for five years.

Those who opt out wouldn’t be eligible for any subsidies in the exchanges. And under this scenario, they wouldn’t be covered by one of the most popular protections in the legislation — the ban on insurers excluding people with pre-existing conditions. People who opted out could still shop for insurance, but there would be no guarantee that they could find an insurer to cover them, at a price they could afford.

Then there could be waiting periods or penalties for waiting (as in Medicare Part B). At any rate, if enough people think this is an important issue, I’m sure we can find a reasonable solution.

Note added: You might want to check out FireDogLake which lists 8 alternatives to the individual mandate.

Health care debate: preexisting conditions and individual mandate

Health care debate: preexisting conditions and individual mandate

Posted on by Jack

The Affordable Care Act (aka ObamaCare) includes a provision requiring individuals to have a certain level of health insurance or pay a penalty. This is commonly called the individual mandate. And is often thought needed for the health care law’s provisions preventing insurance companies from denying coverage to those with preexisting conditions.

Depending on who you listen to there has been either elation or disappointment over the news lately that a Virginia judge has ruled the individual mandate unconstitutional. Of course this one decision and the next judge could support it or disagree but one thing we do know is there will continue to be litigation on this and the issue may end up in the Supreme Court.

Striking down the individual mandate by the courts or perhaps a repeal of this provision would be bad news indeed for those who believe our health insurance system should cover preexisting conditions. It is possible that the individual mandate will be preserved (and some think it likely) but shouldn’t those who believe we should cover preexisting conditions be thinking about a Plan B just in case the individual mandate is out of the picture.