Individual Mandate Now Gone, G.O.P. Targets the One for Employers

From the New York Times:

Having wiped out the requirement for people to have health insurance, Republicans in Congress are taking aim at a new target: the mandate in the Affordable Care Act that employers offer coverage to employees.

And many employers are cheering the effort.

While large companies have long offered health benefits, many have chafed at the detailed requirements under the health law, including its reporting rules, which they see as onerous and expensive. Now that relief has been extended to individuals, some companies believe they should be next in line.

The individual mandate and the employer mandate are “inextricably entwined,” said James A. Klein, the president of the American Benefits Council, an influential lobby for large companies like Dow Chemical, Microsoft and BP, the oil and gas producer.

“It is inequitable to leave the employer mandate in place when its purpose — to support the individual mandate — no longer exists,” Mr. Klein said. “We are urging Congress to repeal the employer mandate.”

Opposition to the employer mandate could increase as more employers are fined for not offering coverage or for not meeting federal standards for adequate, affordable coverage. Since October, the Internal Revenue Service has notified thousands of businesses that they owe money because they failed to offer coverage in 2015, when the mandate took effect.

Representatives Devin Nunes of California and Mike Kelly of Pennsylvania, both Republicans, recently introduced a bill, supported by party leaders, to suspend the mandate, canceling any penalties that would be imposed for any year from 2015 to 2018.

“The employer mandate is a job-killer, a wage-killer and a business-killer,” Mr. Kelly said.

But Tom Leibfried, a health care lobbyist at the A.F.L.-C.I.O., called the proposals to repeal or weaken the employer mandate “a very bad idea.”

“The Affordable Care Act was built on a framework of shared responsibility,” Mr. Leibfried said. “If you get rid of the employer mandate, you will see people lose coverage from their employers.”

Such a move could also increase costs for the federal government. Even though Congress has eliminated the penalties for people who go without insurance, millions of consumers are still eligible for financial aid in the form of tax credits to help them pay insurance premiums. These subsidies increase with the rapidly rising cost of insurance. If fewer people receive coverage from employers, more will qualify for subsidized coverage in the public marketplaces created by the Affordable Care Act.

“The employer mandate holds down the cost of premium tax credits for the federal government,” said Catherine E. Livingston, a tax lawyer at the law firm Jones Day who was the health care counsel at the I.R.S. from 2010 to 2013. “Any employee who receives an offer of affordable coverage from an employer is not eligible for the tax credit. And the employer mandate provides a strong incentive for employers to offer affordable coverage.”

Read the complete article here.

Why the U.S. Spends So Much More Than Other Nations on Health Care

From today’s New York Times:

The United States spends almost twice as much on health care, as a percentage of its economy, as other advanced industrialized countries — totaling $3.3 trillion, or 17.9 percent of gross domestic product in 2016.

But a few decades ago American health care spending was much closer to that of peer nations.

What happened?

A large part of the answer can be found in the title of a 2003 paper in Health Affairs by the Princeton University health economist Uwe Reinhardt: “It’s the prices, stupid.

The study, also written by Gerard Anderson, Peter Hussey and Varduhi Petrosyan, found that people in the United States typically use about the same amount of health care as people in other wealthy countries do, but pay a lot more for it.

Ashish Jha, a physician with the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute, studies how health systems from various countries compare in terms of prices and health care use. “What was true in 2003 remains so today,” he said. “The U.S. just isn’t that different from other developed countries in how much health care we use. It is very different in how much we pay for it.”

A recent study in JAMA by scholars from the Institute for Health Metrics and Evaluation in Seattle and the U.C.L.A. David Geffen School of Medicine also points to prices as a likely culprit. Their study spanned 1996 to 2013 and analyzed U.S. personal health spending by the size of the population; its age; and the amount of disease present in it.

They also examined how much health care we use in terms of such things as doctor visits, days in the hospital and prescriptions. They looked at what happens during those visits and hospital stays (called care intensity), combined with the price of that care.

The researchers looked at the breakdown for 155 different health conditions separately. Since their data included only personal health care spending, it did not account for spending in the health sector not directly attributed to care of patients, like hospital construction and administrative costs connected to running Medicaid and Medicare.

Over all, the researchers found that American personal health spending grew by about $930 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion (amounts adjusted for inflation). This was a huge increase, far outpacing overall economic growth. The health sector grew at a 4 percent annual rate, while the overall economy grew at a 2.4 percent rate.

You’d expect some growth in health care spending over this span from the increase in population size and the aging of the population. But that explains less than half of the spending growth. After accounting for those kinds of demographic factors, which we can do very little about, health spending still grew by about $574 billion from 1996 to 2013.

Did the increasing sickness in the American population explain much of the rest of the growth in spending? Nope. Measured by how much we spend, we’ve actually gotten a bit healthier. Change in health status was associated with a decrease in health spending — 2.4 percent — not an increase. A great deal of this decrease can be attributed to factors related to cardiovascular diseases, which were associated with about a 20 percent reduction in spending.

Read the complete article here.

Takeaways From Tuesday’s Elections

From today’s New York Times Election Review:

By any measure, Tuesday was a big night for Democrats, especially in Virginia, where they swept the top offices, including governor, and made strong gains in the General Assembly. Here are some key takeaways from the biggest election night since President Trump’s victory a year ago.

Susan Johnston helping coordinate canvassing efforts at the Mainers for Health Care headquarters in Portland on Tuesday. Maine became the first state to vote to expand Medicaid. 

A suburban rebellion propels Democrats. It was largely a suburban rebellion, where more moderate voters rejected Mr. Trump and embraced Democrats. Be it New Jersey, Virginia or Charlotte, N.C., Democrats rode a miniwave of victories that will give them energy for candidate recruitment and fund-raising heading into the midterm elections next year.

In addition to winning the top races, for governor of New Jersey and Virginia, Democrats also captured the mayoral post in Manchester, N.H., the State Senate in Washington, along with other important victories in statehouse elections. Maine also became the first state to vote to expand Medicaid, the 32nd in all under President Barack Obama’s signature Affordable Care Act.

It’s hard to have Trumpism if you don’t have Trump. Ed Gillespie, the Republican candidate for governor in Virginia, tried his best to sound the call of Mr. Trump’s followers in stoking the nation’s culture wars. He was harsh on immigration, supportive of Confederate monuments and opposed to those N.F.L. players who have taken a knee. But his public record before, as a national party chairman, White House counselor and Washington lobbyist, had few of those harsh edges. And like a lot of Republicans, he only grudgingly supported Mr. Trump’s candidacy. Most notably, Mr. Gillespie did not seek to campaign with the president in Virginia, settling for support via Twitter. That left him with almost all of Mr. Trump’s baggage and few potential benefits.
Read the entire review article here.

Hidden tax on expensive health care coverage may hurt public workers

Under the Affordable Care Act (ACA) many states that see the wisdom of compliance are setting up health insurances exchanges, but under a little known provision called the “Cadillac Tax,” public unions in particular may be punished for winning their members generous plans with little flexibility for changing them.

The tax was inserted into the ACA at the last minute with the encouragement of many economists who argued that generous plans made consumers insensitive to the spiraling costs of health care. Plans with greater benefits and coverage gained popularity among government employees, police officers, firefighters and teachers unions, but effectively insulated the individually insured from absorbing the skyrocketing costs of coverage.

The tax will affect public unions employees adversely because their plans, which are covered by collective bargaining measures, are more difficult to change without incurring substantial losses. As a result workers will be penalized by the ACA for having good health care coverage, a result that was not intended according to many economists.

“I think it was misguided all along,” said former labor secretary Robert Reich. He complained that the tax amounted to “a blunt instrument that could too easily become a bargaining chip for cutting back benefits of workers. Apparently, that’s what it’s become.”

According to the tax measure, any plan with a cost above a certain threshold in 2018, $10,200 annually for individual plans and $27,500 for family plans, will be taxed at 40 percent of their costs in excess of the limit. Although some cutoffs exist for retirees and some workers in high-risk professions such as police officers, the tax will hurt a number of public union employees.

Many see a disadvantage here that runs contrary to the spirit of ACA to make health insurance more accessible by making it more affordable. Public employee unions from Boston to Orange County are now trying to find ways of cutting health care benefits to avoid the tax charge set to take place in 2018. However, some economists contend that reining in the costs of health care is what the ACA is primarily designed to do.

“This is intended to shift compensation away from excessively generous health insurance toward wages,” said Jonathan Gruber, an economist at MIT and Obama health care policy advisor.

Blame it on Obama? Don’t forget Republicans to blame for this mess

Tonight is the third and final presidential debate before the election next month. The primary focus of this debate in Boca Raton, FL will be foreign policy, but most commentators agree that the economy remains the number one concern on voters’ minds.

Former Gov. Mitt Romney will try to do two things in tonight’s debate:  capitalize on irrational anti-Obama discontent over the economy, and then displace it on the President’s record on foreign policy. Most experts agree that the Obama Administration has been deft and pragmatic on the international stage in a time of tumultuous change in the Middle East and a contracting global economy. Nevertheless, his detractors-cum-international-relations-experts grasp at straws. For example, they blame the President for the actions of Libyan terrorists in the death of Ambassador Chris Stevens. They also claim he is at fault for the widespread discontent in the Muslim world over the same things they are angry about, including diminished economic opportunities and a growing sense that the “system” is out of control. That is a lot of responsibility for someone with so little control over the ways of the world.

Such misplaced blame is a little like blaming God for bad luck. Why do bad things happen to good people? Their reaction is much like the first wave of Job’s reaction to his own suffering:  blame God.  Yet, the answer is more simple if not difficult to acknowledge openly. Instead of being honest about their responsibility for facilitating the present economic mess, or even being realistic about its scope and the time it will take to clean it up, Republicans such as Romney and Rep. Paul Ryan prefer instead to be guided by their anger, even their xenophobic and irrational fears that Barack Hussein Obama is not an authentic American. They place everything that is wrong both home and abroad squarely on his shoulders, rather than seeing the situation for what it is—the harvest reaped by their own policies of economic deregulation, expensive pre-emptive wars, and stupid tax cuts that the country could not afford in the first place. Job, too, was blind before he could see.

The cultivation of these irrational impulses by Fox News, the Republican establishment, and wealthy billionaires who are spending record amounts of their personal money to influence elections through Super PACs and commercial lies is revealing. Times are tough, so blame it on Obama.

If you have lost your job because Wall Street traders, investment bankers, and business executives over the last decade made bad decisions on unacceptably risky calculations with no accountability for their actions, blame it on Obama.

If you cannot find a job because American corporations no longer make real products requiring good paying jobs, while sitting on record mountains of cash that inflate their bottom lines to prop up the short-term, short-sighted expectations of greedy investors, blame it on Obama.

If you think the rising cost of health care is crippling small businesses, but prefer to do nothing about it rather than risk taking any steps along the road to reform, blame Obama.

Never mind that to blame Obama for pursuing health care reform, you have to ignore that former Gov. Romney is the original architect of “Obamacare” in Massachusetts. The truth of the Affordable Care Act is that it uses market principles to ensure that competition among private insurers brings down the cost of insuring all individuals who otherwise could not afford it and whose health care costs would be absorbed by those of us who can afford it—through higher premiums and spiraling emergency room costs. In short, you have to believe falsely in the rhetoric that the ACA is a government takeover of health care, and ignore the fact that it simply incentivizes private insurance and requires all individuals to be responsible for their own health care.

Gov. Romney has done nothing but run a competitive campaign in an easy political climate. It’s an easy thing to blame one man on the world’s problems. That pretty much sums up the Republican policy for turning American around:  get rid of the sitting Democratic president at all cost. But let’s not forget how we got into this mess in the first place. Let’s not forget that America is in a time of crisis because policy choices were made in the past, and they were poor choices. Reversing the consequences of those choices is not something that can be done overnight, let alone in four years. Blaming the President won’t change the past, even if we try to forget that it is the past that is prologue.

If “some” Americans think we cannot afford four more years of Obama, they should consider that the reason America cannot afford much of anything right now is due primarily to those poor policy choices. Demanding that we return power to the party that not only made those choices but want to make them all over again, is not a solution to America’s problems—it is a suicide pact we “other” Americans are wisely unwilling to go along with.

SCOTUS upholds ACA, including individual mandate for the uninsured

In a surprising ruling the Supreme Court today announced that the Americans With Care Act (ACA) is, in fact, constitutional according to the broad tax authority granted Congress by the Constitution.

Opponents of ACA were also dealt a stunning defeat in their argument that so-called “Obamacare” is unconstitutional because it permits the federal government to overreach its legitimate constitutional authority to regulate interstate business according to the Commerce Clause. The majority ruled that the ACA’s individual mandate is not an interstate commerce issue. Chief Justice John Roberts, writing for the majority in a stunning reversal of the swing vote normally reserved for Justice Anthony Kennedy, claimed the law allowed a choice to uninsured but penalized them with a tax if they chose not to get health insurance. That was the Obama administration’s back up argument, and the Supreme Court agreed.

The fact that Roberts sided with the majority and wrote the opinion underscores just how important this ruling is for non-partisan legitimacy of the new health care law. Although critics have scorned the law as “socialism” and derided it based on false assumptions and ignorance about the law’s many benefits, the ruling today represents a major victory for progress in developing a health care system that is both fair and just.

Some benefits of the Affordable Care Act:

  • Children will be able to stay on their parents health plans until age 26, an important benefit in an economy with high unemployment and shrinking benefits.
  • Insurers will no longer be able to discriminate against persons with prior medical conditions.
  • States must set up insurance exchanges so that market competition among firms will deliver low cost insurance to the uninsured.
  • Individuals who can afford insurance but lack it will be penalized by a “free-rider” tax, ensuring that their uninsured medical costs are not passed along to those persons with insurance in the form of higher premiums, more costly health care delivery, and higher taxes for public emergency rooms.