When I set out to write a weekly column on Obamacare, I could not have imagined what a daunting task was before me. I thought it would be simple enough to read the entire bill and then break it down, section by section, and explain it so that we could all better understand how the new healthcare legislation will ultimately affect everyone. Small business owners, health care providers, seniors, patients with chronic illnesses…everyone has a vested interest. I planned to leave the politics out of it, to the best extent possible, and just focus on the facts. However when I interviewed doctors and small business owners, I found that people are so passionate about this issue and have so much to say, that the politics always made its way back into the discussion. Still, I will do my best to present facts only. Texas PolitiChick Lara Maertans Rhea
Another potential problem with Obamacare is the fact that many large companies who currently provide coverage for their employees will likely opt to pay the mandate and drop their existing coverage. If their fine per employee is $2000 a year and the company would otherwise have to pay $5000 a year for healthcare benefits, many will opt for the fine in order to cut costs. Then we are back to the drawing board with more uninsured workers. Then of course there is that issue of who really pays the cost to employers. Large companies will try to absorb the cost by shifting the burden to the employees via pay cuts, lay-offs, etc. Consumers will also pick up the tab with rising costs of goods and services. Small business owners who must provide coverage for each employee might not be able to afford the coverage or the fines and have to resort to closing their doors.
So to be sure, there will be future attempts to repeal or change various aspects of the bill. Republicans will push to repeal it in its entirety or fight to change certain parts, but they risk upsetting voters by eliminating popular provisions in the bill. Almost no one likes the current policy of exclusions for pre-existing conditions and lifetime policy caps, so the Republicans need solutions that keep certain aspects of the legislation where people find favor.
Even if Obama is reelected, however, he will be battling many Democrats. In Minnesota and Massachusetts, for example, there are many who oppose the medical-device tax that is part of the legislation. This is a $20 Billion tax based on a 2.3% excise tax levied on the total revenues of over 16,000 companies beginning in 2014, regardless of whether or not those companies generate a profit. This means that many companies will owe more in taxes than they generate. This would clearly have a negative impact on innovation, technology, patient care, and jobs. So Democrats in areas where this legislation is hard-hitting are challenging this part of the bill.
This is only one example, but the attempts to modify the law will be ongoing. Congress has the authority to review and veto regulations under the Congressional Review Act, so it can block regulations as long as there are majority votes in both Houses with a presidential signature. This is why this upcoming presidential election is so important to so many people.
In the meantime, there is legislation in place and many people do not realize that many rules are already in effect. Changes began in 2010, the mandates begin in 2014, meaning that by then, every American is supposed to be insured (Question #4) and by 2020 the entire law will be in effect. The biggest changes are happening now and through 2014.
So finally, what are some of the changes that have already occurred and what can we expect in the near future?
The Food and Drug Administration can now approve more generic drugs that help to drive down prices on prescriptions. There are more rebates on drugs people get through Medicare. Restaurant chains must display how many calories are in all of their foods. Insurance companies are forbidden to discriminate based on disability. High-risk patients must be offered insurance in a high-risk pool. Children under 19 cannot be denied coverage for pre-existing conditions. Insurance companies cannot drop clients when they become ill and they must have an appeals process when they deny a claim. Medicare benefits now extend to smaller hospitals. Limits are placed on insurers so that they cannot price-gouge customers. Employers must list the benefits they provide to their employees on their tax forms, and all new health plans must offer and provide preventative care such as mammograms and colonoscopies without a co-pay or upfront charge.
By 2014, no one can be denied coverage for pre-existing conditions. If you do not fall under the exemption, you must purchase a healthcare policy or be charged a fee. Medicaid benefits will be extended. Small businesses with less than 25 employees will get some tax credits for two years. Businesses with over 50 employees will have to provide health insurance to all full-time employees or pay the penalties. There will no longer be lifetime spending caps and customers can receive as much health care as they need in any given year. Medicare spending will be cut. If you have health savings account, you will be taxed on anything put in the account over $2500. Pharmaceutical companies, medical device companies, and insurance companies will face new taxes. You will no longer be able to deduct many medical expenses from your income taxes.
By 2015, doctors’ pay will be determined by the quality of their care. According to a recent study by the Association of American Medical Colleges and reported by Reuters, this will lead to a 63,000 shortage of doctors. With a cap on reimbursements and education becoming more expensive, and the unattractiveness of taking Medicare and Medicaid patients, fewer and fewer are expected to go into the field of medicine.
By 2017, states will be able to offer their own individual health care plans. In 2018, all plans will have to cover preventative care. There will be a tax imposed on the better health care plans that wealthier people can afford. The Medicare gap will be eliminated by 2020.
So there you have it, condensed as much as possible. Next week I will talk more in depth about the mandates, the Supreme Court ruling, and more positives and negatives of the legislation and the impact on everyday Americans. As stated before, the more informed we are, the more we can turn to our elected officials to change or remove what we don’t like about the bill and implement the parts that are beneficial.