Wednesday, March 14, 2012

We Won’t Know What’s In There Until We Pass It


When the Affordable Patient Protection Bill (APPA) bill was in congress many congressman could not or did not read the entire bill.  The bill was 1200 pages of the “Secretary of HHS” shall implement the following”…………..The bill was global, including many issues with health IT, public health, ACOs, and  set deadlines for implemenation without regard to the impact of each phase.

Some said that we would not now what was in it until it was passed.  That statement is probably the most true statement of the entire furor over health reform.

The initial phase included forbidding exclusions for previous illness and doing away with uninsurabilty as well as allowing dependent minors to remain on parent’s policies until the age of  25.  Those two items surely drove up the cost of health insurance.  Someone had to pay for insuring uninsurable people. Surely it sounds wonderful and it immediately reduced political pressure about health reform.

It may have been a bit backward to set up the financing after increasing the expense. I don’t understand the math but then again I don’t print money.

Torn Money

Jeff Young, at the Huffington Post describes it this way.

“The good news is that health care reform could lead your employer to put a little more money in your paycheck. The bad news is that if they do, it's probably because they aren't providing you with health insurance anymore.

The Congressional Budget Office estimates that 4 million fewer people will get health benefits from their employers in 2016 compared to what the agency projected a year ago. More people will end up on Medicaid, the government health program for the poor, and more companies will decide to stop offering health benefits and let their workers buy their own coverage through insurance "exchanges" the government will establish in 2014. The Congressional Budget Office doesn't estimate how much wages might increase for those who lose company health benefits.

How could this translate into bigger paychecks for workers? Economists consider health insurance to be part of how much companies "pay" workers because fringe benefits cost them money, said Paul Fronstin, director of the Health Research & Education Program at the Employee Benefit Research Institute. If a company decides to stop providing health insurance, they are likely to pay a little more. Companies may choose to offer workers extra money that could be used to help pay for health insurance instead of providing benefits themselves.

The Congressional Budget Office also says this will allow the government to raise more money to pay for health reform because wages get taxed but money spent on workplace health benefits doesn't. Employers that drop workers from their insurance rolls also will pay penalties to the government.

Jobs would remain the most common way for Americans to get health insurance. The new projections about health care reform don't say fewer people overall will get insurance at work, just a smaller number than the budget agency previously thought. This year, 154 million people are covered by their employers and 161 million will be in 2016, the Congressional Budget Office says.

There's no guarantee things will play out that way. Economic and budget projections are constantly changing and the parts of the health care law that are supposed to expand coverage don't exist yet. Moreover, Fronstin said, economists' assumptions about companies treating benefits like pay aren't always accurate in the real world.

Reading further it becomes obvious there are many  ‘what if's’ an unspoken hope that the present economic doldrum will come to an end, and the planners have given themselves more than ‘wiggle room’ to call it a success.

Whatever it is we should not blame “Obama Care”  Much of the ideas were formulated long before he came into office.

The Patient Affordability and Protection Act is the correct term. That term seemed the most innocuous and benevolent term for major disruption and uncertainty in the health system.

Part II (later this week)

Health Insurance Exchanges, to be….or not to be. Who will do it?


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