How the health care law will be enforced

A major argument against the government taking over Americans’ health care is competence, the fear that the government is just not competent enough to supervise such an important part of life.  Here is an example:

The IRS processed more than 230 million tax returns last year, paid 127 million refunds and received about 68 million phone calls. The agency is responsible for enforcing a tax code that, at 71,000 pages, makes Anna Karenina look like a comic book.

Starting in 2014, the agency will have another task: making sure all Americans have health insurance. Under the law, Americans who can afford health insurance but refuse to buy it will face a fine of up to $695 or 2.5% of their income, whichever is higher. More than 4 million Americans could be subject to penalties of up to $1,000 by 2016 if they fail to obtain health insurance, the Congressional Budget Office said last week.

The IRS will be the enforcer — sort of.

While the IRS can impose liens or levies, seize property or seek jail time against people who don't pay taxes, it’s barred from taking such actions against taxpayers who ignore the insurance mandate. In the arsenal instead: the ability to withhold refunds from taxpayers who decline to pay the penalty, IRS Commissioner Doug Shulman said this month.

Still, compliance with the health reform law will be largely voluntary, says Timothy Jost, a law professor at Washington and Lee University. “By taking criminal sanctions and liens and levies off the table, the IRS’s hands are tied, to a considerable extent.”

The IRS is “being put in a position where it will be sending notices that will annoy people” and not much else, says James Maule, professor of law at Villanova University and author of the tax blog MauledAgain. “It’s basically designed for failure.”

via IRS lacks clout to enforce mandatory health insurance – USATODAY.com.

So according to the jury-rigged, Rube Goldberg provisions of the law, an agency that has a completely different purpose is asked to enforce the law, and then the mechanisms necessary to enforce it are taken away. How can this possibly work?

About Gene Veith

Professor of Literature at Patrick Henry College, the Director of the Cranach Institute at Concordia Theological Seminary, a columnist for World Magazine and TableTalk, and the author of 18 books on different facets of Christianity & Culture.

  • Daniel Gorman

    So the insurance mandate is only a mandate for those who choose to overpay their income tax?

    Those challenging the constitutionality of the Obamacare don’t have much of a case. No one is being forced to buy insurance or pay a tax. Simply reduce your withholding if you don’t want to buy insurance!

    Of course, healthy young men and women will quickly figure this out. They will wait until they actually get sick to buy insurance. Premiums for the rest of us will rise proportionally.

    The Republican Congress (2001-2006) could have passed a bill to give a tax credit for buying insurance (with cost containment to prevent gouging) and thereby eliminated pre-existing conditions. Instead they gave a big tax cut to the rich and trillions to big Pharma and insurance companies. Let’s hope they have learned their lesson when they repeal and replace Obamacare.

  • Daniel Gorman

    So the insurance mandate is only a mandate for those who choose to overpay their income tax?

    Those challenging the constitutionality of the Obamacare don’t have much of a case. No one is being forced to buy insurance or pay a tax. Simply reduce your withholding if you don’t want to buy insurance!

    Of course, healthy young men and women will quickly figure this out. They will wait until they actually get sick to buy insurance. Premiums for the rest of us will rise proportionally.

    The Republican Congress (2001-2006) could have passed a bill to give a tax credit for buying insurance (with cost containment to prevent gouging) and thereby eliminated pre-existing conditions. Instead they gave a big tax cut to the rich and trillions to big Pharma and insurance companies. Let’s hope they have learned their lesson when they repeal and replace Obamacare.

  • Tom Hering

    Okay, you don’t buy the required insurance. So your refund is intercepted. The next year, you do buy the required insurance. But your refund may still be intercepted – and intercepted again the year after that – until your total fine is paid. What’s “not effective” about that? It’s not much different from local government adding unpaid fines to your property tax bill at the end of the year.

  • Tom Hering

    Okay, you don’t buy the required insurance. So your refund is intercepted. The next year, you do buy the required insurance. But your refund may still be intercepted – and intercepted again the year after that – until your total fine is paid. What’s “not effective” about that? It’s not much different from local government adding unpaid fines to your property tax bill at the end of the year.

  • DonS

    So, if you don’t want to buy the insurance, make sure you pay little enough in taxes during the year so that you won’t be eligible for a refund. That’s easy enough to do by adjusting your tax withholdings. Then, I guess that you are immune from this ridiculous law.

    We all knew beforehand that this whole provision was a crock. It was discussed on this very thread time and time again. We as a nation are reaping what we sowed back in 2008.

  • DonS

    So, if you don’t want to buy the insurance, make sure you pay little enough in taxes during the year so that you won’t be eligible for a refund. That’s easy enough to do by adjusting your tax withholdings. Then, I guess that you are immune from this ridiculous law.

    We all knew beforehand that this whole provision was a crock. It was discussed on this very thread time and time again. We as a nation are reaping what we sowed back in 2008.

  • DonS

    Oops, “thread” should be “blog” in post #2.

  • DonS

    Oops, “thread” should be “blog” in post #2.

  • Leo H.

    We need a single payer system. Medicare needs to be extended to all Americans.

  • Leo H.

    We need a single payer system. Medicare needs to be extended to all Americans.

  • http://mesamike.org Mike Westfall

    We ought to have a single-payer system for groceries, too. Food stamps need to be extended to all Americans.

  • http://mesamike.org Mike Westfall

    We ought to have a single-payer system for groceries, too. Food stamps need to be extended to all Americans.

  • Leo H.

    Yes, Mike Westfall, food needs to be extended to all Americans.

    In 2008, household food insecurity rose more than 35 percent due to the recession and increased unemployment. More than 49 million people — including 16.7 million children — live in households that experience hunger or the risk of hunger. This represents more than one in seven households in the United States (14.6 percent).
    5.7 percent of U.S. households experience hunger. Some people in these households frequently skip meals or eat too little, sometimes going without food for a whole day. 17.3 million people, including 1.1 million children, live in these homes.
    8.9 percent of U.S. households are at risk of hunger. Members of these households have lower quality diets or must resort to seeking emergency food because they cannot always afford the food they need. 31.8 million people, including 15.6 million children, live in these homes.
    Research shows that preschool and school-aged children who experience severe hunger have higher levels of chronic illness, anxiety and depression, and behavior problems than children with no hunger.

    (source) http://www.bread.org/learn/hunger-basics/hunger-facts-domestic.html

  • Leo H.

    Yes, Mike Westfall, food needs to be extended to all Americans.

    In 2008, household food insecurity rose more than 35 percent due to the recession and increased unemployment. More than 49 million people — including 16.7 million children — live in households that experience hunger or the risk of hunger. This represents more than one in seven households in the United States (14.6 percent).
    5.7 percent of U.S. households experience hunger. Some people in these households frequently skip meals or eat too little, sometimes going without food for a whole day. 17.3 million people, including 1.1 million children, live in these homes.
    8.9 percent of U.S. households are at risk of hunger. Members of these households have lower quality diets or must resort to seeking emergency food because they cannot always afford the food they need. 31.8 million people, including 15.6 million children, live in these homes.
    Research shows that preschool and school-aged children who experience severe hunger have higher levels of chronic illness, anxiety and depression, and behavior problems than children with no hunger.

    (source) http://www.bread.org/learn/hunger-basics/hunger-facts-domestic.html

  • http://mesamike.org Mike Westfall

    I’m with you, Leo.
    I get hungry every day, myself…

  • http://mesamike.org Mike Westfall

    I’m with you, Leo.
    I get hungry every day, myself…

  • Leo H.

    Mr. Westfall,
    May God forgive your smug contempt for those whom Christ tells us to help.

  • Leo H.

    Mr. Westfall,
    May God forgive your smug contempt for those whom Christ tells us to help.

  • http://mesamike.org Mike Westfall

    So, Leo,

    Maybe you can explain why you think EVERYBODY needs to be on federal assistance, whether they want it or not, whether they need it or not.

    What’s so appealing about “single payer” systems of provision?

  • http://mesamike.org Mike Westfall

    So, Leo,

    Maybe you can explain why you think EVERYBODY needs to be on federal assistance, whether they want it or not, whether they need it or not.

    What’s so appealing about “single payer” systems of provision?

  • http://barrybishop.blogspot.com/ Barry D. Bishop

    Ok, I did the math. I currently pay $600 a month for health insurance for my family of five. So 600 * 12 = $7,200 per year that I pay for the insurance (this doesn’t include copays, meds, etc.)

    I currently have an annual salary of $45K
    So 2.5 percent of 45,000 = $1,125

    Mathematically, why would I carry health insurance then? For less than what I pay for 2 months, I could pay the fine and have insurance when I need it. Also, the IRS withholding a refund from me is no big deal because whatever the refund is could be subtracted from fine owed.

    I am not the only one that can do simple math to see how to come out ahead financially. I suspect many Americans will chose the path that leaves more money in their pockets.

    However, I am still thinking through the biblical and moral implications of not carrying health insurance.

  • http://barrybishop.blogspot.com/ Barry D. Bishop

    Ok, I did the math. I currently pay $600 a month for health insurance for my family of five. So 600 * 12 = $7,200 per year that I pay for the insurance (this doesn’t include copays, meds, etc.)

    I currently have an annual salary of $45K
    So 2.5 percent of 45,000 = $1,125

    Mathematically, why would I carry health insurance then? For less than what I pay for 2 months, I could pay the fine and have insurance when I need it. Also, the IRS withholding a refund from me is no big deal because whatever the refund is could be subtracted from fine owed.

    I am not the only one that can do simple math to see how to come out ahead financially. I suspect many Americans will chose the path that leaves more money in their pockets.

    However, I am still thinking through the biblical and moral implications of not carrying health insurance.

  • http://www.toddstadler.com/ tODD

    Barry (@11), I am not hiring you to be my actuary.

    Seriously, if you’re going to do a cost-benefit analysis, please do. But do a full one. If you think that the only two figures you need to consider are the cost of health insurance vs. the cost of the penalty, though, you haven’t thought it through.

    At some point, you have to ask yourself what happens if you get sick. If you get sick with health insurance, you’re covered (within the terms of your insurance). If you get sick without health insurance, you might possibly have your issues addressed at an ER. Depends. The question is: what is the choice between those two options worth to you?

    Time was, if you were young and/or healthy enough, the cost to you was (effectively) $0. It’s obviously more than that now. Of course, if you’re young and don’t need insurance, you probably don’t have a family of five, either, so the $7,200 figure you cite isn’t likely to be relevant to such a person.

    Mike (@6), I don’t think you understand the different kinds of demand there are for food and medical insurance.

  • http://www.toddstadler.com/ tODD

    Barry (@11), I am not hiring you to be my actuary.

    Seriously, if you’re going to do a cost-benefit analysis, please do. But do a full one. If you think that the only two figures you need to consider are the cost of health insurance vs. the cost of the penalty, though, you haven’t thought it through.

    At some point, you have to ask yourself what happens if you get sick. If you get sick with health insurance, you’re covered (within the terms of your insurance). If you get sick without health insurance, you might possibly have your issues addressed at an ER. Depends. The question is: what is the choice between those two options worth to you?

    Time was, if you were young and/or healthy enough, the cost to you was (effectively) $0. It’s obviously more than that now. Of course, if you’re young and don’t need insurance, you probably don’t have a family of five, either, so the $7,200 figure you cite isn’t likely to be relevant to such a person.

    Mike (@6), I don’t think you understand the different kinds of demand there are for food and medical insurance.

  • http://spaceagelutheran.blogspot.com/ SAL

    What a mess. The central government has control of too many things to control any them well.

    Authority over matters like healthcare needs to be returned to the people and the states.

  • http://spaceagelutheran.blogspot.com/ SAL

    What a mess. The central government has control of too many things to control any them well.

    Authority over matters like healthcare needs to be returned to the people and the states.

  • sg

    Just got the going-out-of-business letter from my kid’s pediatrician. He cites falling reimbursements over the past seven years. He said he will transfer the patient records to another practice as of the end of May. Coincidently (or not) the doctors there are all women. The AEI blog reports that now 125 women for every 100 men graduate medical school. Generally when women enter a field, compensation falls. I wrote him a letter asking him to start or join a cash only practice.

  • sg

    Just got the going-out-of-business letter from my kid’s pediatrician. He cites falling reimbursements over the past seven years. He said he will transfer the patient records to another practice as of the end of May. Coincidently (or not) the doctors there are all women. The AEI blog reports that now 125 women for every 100 men graduate medical school. Generally when women enter a field, compensation falls. I wrote him a letter asking him to start or join a cash only practice.

  • Helene

    I’m hoping to find a doctor who’ll accept chickens in payment. That seems to be where we’re going if the GOP wins in November.

  • Helene

    I’m hoping to find a doctor who’ll accept chickens in payment. That seems to be where we’re going if the GOP wins in November.

  • http://mesamike.org Mike Westfall

    Helene, can you explain what you mean by your drive-by comment?

    As it is, I’ve heard of some doctors now providing services on a cash-only basis. Not because of anything the GOP did, but because of the onerous requirements for dealing with insurance companies the Obamacare bill mandates.

    We are a lot closer to the chicken-barter health care economy than we’ve been in many generations, it seems to me.

  • http://mesamike.org Mike Westfall

    Helene, can you explain what you mean by your drive-by comment?

    As it is, I’ve heard of some doctors now providing services on a cash-only basis. Not because of anything the GOP did, but because of the onerous requirements for dealing with insurance companies the Obamacare bill mandates.

    We are a lot closer to the chicken-barter health care economy than we’ve been in many generations, it seems to me.

  • helen

    We are a lot closer to the chicken-barter health care economy than we’ve been in many generations, it seems to me. –Mike Westfall

    LOL! How many generations, Mike? Would it surprise you to know that there are people still alive who remember the last Depression? [Note: the banks were involved in that one, too.] :(

  • helen

    We are a lot closer to the chicken-barter health care economy than we’ve been in many generations, it seems to me. –Mike Westfall

    LOL! How many generations, Mike? Would it surprise you to know that there are people still alive who remember the last Depression? [Note: the banks were involved in that one, too.] :(

  • http://barrybishop.blogspot.com/ Barry D. Bishop

    tODD @12,
    If you are still following this thread, I just wanted to say I appreciate your comments and I am considering that there are costs to health care beyond premiums and penalties.

    I am sure there are many who are better at math than me.

    However, I believe that many Americans will come to the same conclusions as me because people tend to be short-sighted and optimistic about money. If they weren’t then the credit card industry would not exist. Do the math on credit cards (that is, having debt on credit cards) and it doesn’t make sense either.

    As to my age, I am 31.

  • http://barrybishop.blogspot.com/ Barry D. Bishop

    tODD @12,
    If you are still following this thread, I just wanted to say I appreciate your comments and I am considering that there are costs to health care beyond premiums and penalties.

    I am sure there are many who are better at math than me.

    However, I believe that many Americans will come to the same conclusions as me because people tend to be short-sighted and optimistic about money. If they weren’t then the credit card industry would not exist. Do the math on credit cards (that is, having debt on credit cards) and it doesn’t make sense either.

    As to my age, I am 31.


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