Befuddled: Health Reform – Where do all the Delays Leave the Little Guy?

With the delay in the mandate for large employers, the author contends we may just be seeing the tip of iceberg in the myriad of problems with Obamacare.

OPINION – July 11, 2013 -- Last week the Obama administration noted that there would be a number of delays in the implementation of Obamacare. I am not sure why the administration thinks it can pick and choose when it would like to implement certain provisions of the law, but I will leave that to the legal scholars.

The good news may be that certain employers who might not have been ready for the new law and prepared to provide health insurance or face the dreaded penalties will have another year to get ready for its implementation in 2015, not 2014. The bad news is that certain individuals subject to the law will still be required to purchase health insurance or pay the penalties in 2014. Although the penalties appear to be much lower than the cost of health insurance, these individuals will still be subject to them in 2014, if they do not purchase health insurance.

One might wonder whether the employer delay will subject more individuals to having to purchase health insurance or pay the penalties. That is, if an individual’s employer would have provided insurance because of the law, it can now wait to do so or pay the penalty in 2015. Where does this leave the little guy? It would seem that more of them will have to purchase insurance or pay the penalty in 2014. Some think that those that are in reasonably good health will go for the penalty, not the insurance. If that happens, we will only continue the current situation we have now where many younger healthy folks choose not to have insurance and thus, are not participating in the healthcare insurance system.

Other notable delays always appear to be the delay in the verification of consumer claims about employer-provided insurance, and permitting individuals to self-report income. Whether individuals will under-report their income to become eligible for subsidized medical coverage through the Health Insurance Exchanges (HIEs) is unknown. And what about those HIEs? Reports coming from the federal government seem to be that they will be good to go. How this comports will all the reports about certain plans and providers not wanting to participate now will yet to be seen. Are we seeing a train wreck in the making or merely a rocky transitional phase?

Oh …, one other consideration will be the costs. Whether one believes the Congressional Budget Office (CHO) numbers or not, if there was supposed to be all this “savings” as a result of Obamacare, what happens when the Employers are not providing health insurance in 2014 or not paying the penalty in 2014? Will this “savings” be paid for by the individuals who now pay the penalty who might not otherwise have had to do so, if their employers provided health insurance? Maybe we will see some new CBO numbers on this in the future, or maybe we will not?

Unfortunately, we may only be seeing the tip of the iceberg in the myriad of problems that we are going to experience with Obamacare. Massachusetts appears to have gone through many growing pains with its “Romney Care,” including additional legislation a few years after enactment attempting to raise additional funds to help pay for it. It will be interesting to see if the Administration has learned anything from the continuing Massachusetts experiment.

From the perspective of this biomedical informatician lawyer, we are going to be in for some very difficult times in this new transitional phase. It would be tragic if the many good things in Health Reform, e.g., payment for quality and cost-effectiveness, elimination of certain coverage restrictions and caps, health care for all, etc., are tossed out with the parts that are increasingly finding do not work and we can ill afford. Many say this cannot happen. They point to the number of times legislation has been introduced in the House of Representatives to repeal Obamacare, but failed. They probably do not recall the history of the Medicare Catastrophic Coverage Act of 1988. The Medicare what? Exactly!

Paul R. DeMuro is an attorney with Schwabe, Williamson & Wyatt and a NLM Post-Doctoral Fellow in the Department of Medical Informatics and Clinical Epidemiology at Oregon Health & Science University. He can be reached at [email protected].

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The stated concerns are legitimate. Let's see some accountability as well for those whose efforts to sabotage the implementation of the ACA have made this more difficult than it would have been, anyway. House and Senate Republicans, sure, but many more as well whose concerns are with their personal or corporate self interest, but certainly not with the tens of millions uninsured and tens of millions more under-insured, nor with the tens of thousands annually whose premature deaths can be attributed to their delaying needed care in favor of food, housing and other needs for themselves or their families, because uninsured or under-insured status made it so. Those are (or were) "little guys" too. A single payer system (horrors!) would have simplified much of this, and may yet if obstruction is the continued strategy of opponents of success.