Will Obamacare decrease health benefits?

The Washington Post‘s Ezra Klein tries to assure businesses that Obamacare won’t be so bad.  But in doing so, he makes me wonder whether a program built largely around employer-provided health insurance might have the effect of eliminating many people’s employer-provided health insurance:

The health-care law’s treatment of larger employers is almost laughably complicated. If you’ve got fewer than 50 employees, nothing is asked of you, and if you’re willing to provide insurance for your employees, you get a giant tax credit, at least for awhile.

But if you’re a business with more than 50 full-time employees, matters become considerably more complex.

If you’ve got more than 50 full-time employees and you already offer them health insurance, you can stop reading now. You’re in the clear.

If you’ve got more than 50 full-time employees and you don’t offer them coverage and you don’t pay them enough to buy coverage on their own without using subsidies, then you have to pay $2,000 for each employee, except for your first 30 employees.

If you’ve got more than 50 full-time employees and you offer some of them coverage but others have to apply for federal subsidies and buy coverage themselves, then you pay the lesser of $3,000 for each employee receiving insurance subsidies or $2,000 for each full-time employee, once again excluding the first 30 employees.

Weird, right? But the complexities of this policy obscure a huge win for employers. In 1974, President Richard Nixon’s health-care plan proposed forcing employers to pay 75 percent of the cost of basic health insurance for their employees, though there would be some assistance for smaller businesses. In 1994, President Bill Clinton proposed forcing employers to pay 80 percent of the cost of basic heath insurance for their employees, though a somewhat confusing series of caps meant that smaller businesses would end up paying much less.

In other words, both Democratic and Republican presidents used to think the proper role for business in the American health-care system was to pay most of the cost of their employee’s health-care insurance.

Under the Affordable Care Act, the principle is different, and much less onerous: Employers don’t need to offer health care, and they don’t need to pay for most of the cost of their employee’s health care, but if their employees are taking advantage of public subsidies, then the employer should have to pay a penalty equal to about 1/8th the cost of the average employer-provided health-insurance plan.

via Cheer up, Papa John’s. Obamacare gave you a good deal..

So if a company has a choice between paying $16,000 (or more, or a large percentage of this amount) for an employee’s health insurance or paying a $2,000 fine, since de-stigmatized as a “tax,” won’t companies have an overwhelming economic incentive to drop health benefits altogether?  It would be far cheaper to pay the tax than to pay for health benefits.

Employees would then have to turn to the “insurance exchanges” to buy their own insurance, possibly with a government subsidy (shooting up the cost to taxpayers), though still with a large expenditure out of their own pockets.  Or they might just join the ranks of the uninsured, paying their own necessary fines or taxes.

Am I missing something, or might Obamacare have exactly the opposite effect that it intended?

 

Obamacare will turn full time jobs into part time

Obamacare will require large companies to provide health insurance for full-time workers. So a number of low-wage employers–restaurants, hotels, and retailers–are planning to limit workers to no more than 30 hours per week to avoid triggering the requirement.

So reports the Wall Street Journal: Health-Care Law Spurs a Shift to Part-Time Workers – WSJ.com. (subscription required)

What are we to think of companies that do this?  Do we blame them?  Do we blame the government?  Is this irresponsible exploitation of labor or an economic necessity?

The Obamacare tax increases

There are some twenty new taxes or tax increases that click in with Obamacare.  Here are the most notable:

The Obamacare Medical Device Tax – a $20 billion tax increase: Medical device manufacturers employ 409,000 people in 12,000 plants across the country. Obamacare imposes a new 2.3 percent excise tax on gross sales – even if the company does not earn a profit in a given year. In addition to killing small business jobs and impacting research and development budgets, this will increase the cost of your health care – making everything from pacemakers to prosthetics more expensive.

The Obamacare “Special Needs Kids Tax” – a $13 billion tax increase: The 30-35 million Americans who use a Flexible Spending Account (FSA) at work to pay for their family’s basic medical needs will face a new government cap of $2,500 (currently the accounts are unlimited under federal law, though employers are allowed to set a cap).

There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are several million families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. This Obamacare tax provision will limit the options available to these families.

The Obamacare Surtax on Investment Income – a $123 billion tax increase: This is a new, 3.8 percentage point surtax on investment income earned in households making at least $250,000 ($200,000 single). . . .

The Obamacare “Haircut” for Medical Itemized Deductions – a $15.2 billion tax increase: Currently, those Americans facing high medical expenses are allowed a deduction to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). This tax increase imposes a threshold of 10 percent of AGI. By limiting this deduction, Obamacare widens the net of taxable income for the sickest Americans. This tax provision will most harm near retirees and those with modest incomes but high medical bills.

The Obamacare Medicare Payroll Tax Hike — an $86.8 billion tax increase: The Medicare payroll tax is currently 2.9 percent on all wages and self-employment profits. Under this tax hike, wages and profits exceeding $200,000 ($250,000 in the case of married couples) will face a 3.8 percent rate instead.

via Americans for Tax Reform : Top Five Worst Obamacare Taxes Coming in 2013.

 

So what will Obamacare cover?

Here I thought Obamacare would just cover abortions and euthanasia.  (Kidding!)

It is among the health-care law’s most important — and most daunting — questions: What health-care benefits are absolutely essential?

California legislators say acupuncture makes the cut. Michigan regulators would include chiropractic services. Oregon officials would leave both of those benefits on the cutting-room floor. Colorado has deemed pre-vacation visits to travel clinics necessary, while leaving costly fertility treatments out of its preliminary package.

Policy experts expected the Affordable Care Act to establish a basic set of health benefits for the nation, but the Obama administration instead empowered each state to devise its own list. When all Americans are required to purchase health insurance in 2014 or pay a penalty, they will find that the plans reflect the social and political priorities of wherever they live.

That nationwide patchwork highlights the difficulty of agreeing on what constitutes good basic health care, as well as the tricky balances that states face in weighing coverage vs. cost.

“I want a benefit package that gives people viable protection but not necessarily a Mercedes,” said Arkansas Insurance Commissioner Jay Bradford, who is still deciding what options to pick for his state.

If insurance plans cover too much, premiums could become prohibitively expensive. But if they skimp on coverage, the states could fail to deliver on the health law’s basic promise: extending quality health coverage to 30 million Americans.

States do have guidelines to work within: They must cover 10 broad categories outlined in the Affordable Care Act, including doctor visits, maternity care and prescription drugs. They also must use an existing health-insurance policy as a template, such as a small-group plan or the package for state employees.

Eleven states have settled on packages of essential health benefits or are close to doing so, according to the consulting firm Avalere Health. Twenty others are still in the process of choosing a plan.

While benefits for hospital care and doctor visits tend to look similar, coverage for alternative medicine and mental health services varies widely.

via Is acupuncture essential health care? Weight-loss surgery? Under Obamacare, states choose.

So some states will pay for fertility treatments, stomach-reduction surgery, and other elective procedures and some won’t.  (I wonder if my cataract surgery would have been covered.  I think I’d hesitate to make a claim for fear of getting the attention of the death panels.  [Kidding!])

Here are the ten areas that must be covered:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management, and
  10. Pediatric services, including oral and vision care

So dental and vision will be covered for children, but not for adults.  Presumably, health insurance plans at work can still offer those and other benefits.  The question is whether the Obamacare mandates will have a flattening effect on insurance offerings.

A big problem with Obamacare is that it’s so complicated and no one knows what it will really do.

But now I see

Things have hard edges.  The leaves on a tree are distinct from each other.  Each pieces of gravel on a path is separate from the others.  Faces in a crowd don’t blur together.  Who knew?

Those who think there are no boundaries between right and wrong, true and false, beautiful and ugly; the blurrers of distinctions; those who think there are only shades of grey; the Hindu sages and New Age gurus who think “all is one”–these people are not just making philosophical errors.  They just need cataract surgery!

Back under the knife

Having completed several weeks of recovery from cataract surgery, we do it all again starting today, as my left eye gets operated on.

Despite the forced inactivity, I was able to keep the blog going pretty well, so I hope can do the same this time.  This eye, though, will be corrected for near vision–the other one was for distant vision–so this operation may affect me more in reading and blogging, at least for a few days until the vision stabilizes.  When that happens, I should see really well in both eyes.  But if I’m not able to blog at my normal pace, you’ll know what has happened.

The plan, after taking out the cataracts, is to put in new artificial lenses that will correct my vision so that I might not even need glasses.   But it will work like this:   My right eye will be for distant vision. My left eye will be for near vision.  My brain supposedly will work the board, cutting from one camera/eye to the other.  This is called “monovision,” and I’m told that quite a few people with contact lenses have this arrangement.

But isn’t “stereo” better than “mono”?  If I just use one eye at a time, won’t that throw off my depth perception?  Will I be able to see 3-D movies?  If not, I don’t really mind, since I have never seen 3-D effects in a movie that I liked, with the exception of the Michael Jackson short film at Disneyland, and this will save me a lot of money in extra ticket prices.  But I’d sort of like to see 3-D effects in real life.

Would glasses let me use both eyes together?  I haven’t been wearing them since the first surgery since the prescription isn’t valid anymore, and I realize that I feel weird not wearing the things.  I actually like wearing glasses.  I hate to give them up, especially since the styles I first wore in 7th grade have finally come back in fashion and are defined as “hipster” frames.

I know, I know, I should have asked my doctor about all of this, but I always want to get out of the doctor’s office as soon as possible.


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