Sunday, September 12, 2010

Health Reform: Don’t Forget the Details

Sometimes, as we ponder the total impact of the Affordable Care Act (ACA), we forget the details.

We forget details like the ACA impacts every American in one way or another – more coverage for 32 million Americans( it extends insurance from 83% to 95% of the population); more costs of up to 9% in 2010 for the remaining 278 million (assuming the 2010 census count is 310 million); more expenses, taxes, and penalties of $150 billion or so for large and small businesses); more taxes for U.S. tax payers (in the neighborhood of $900 billion to $1 trillion over the next years(depending on who is doing the estimates).

We forget details like the individual mandate's constitutionality, the state of Florida is challenging tghe mandate right now in court. On behalf of 20 state attorney generals the mandate has lodged a suit against the mandate, without which Obamacare might collapse.

We forget details like the ACA is 2074 pages long, contains 400,000 words, and is longer or wordier than the Declaration of Independence (1337 words), the U.S. Constitution (4,543 words), War and Peace (1400 words), the Torah (80,000 words).

We forget the ACA document weighs in at 19 pounds, stands 9 inches tall, and costs $2.24 million per word.

Because of the ACA’s size, we forget it is easy to get lost in the details, like a little detail calling for every business to file a 1099 tax form identifying any vendor, supplier, or contracts to whom they pay $600 or more per year for goods or merchandise – food, bottled water, gasoline, labor, office and building supplies, travel, Internet or phone services – including sending copies of the form to vendors, suppliers, and contractors –and printing details of the every $600 transaction in the annual report.

We forget this new $600 filing requirement poses a huge bureaucratic burden, applied to 38 million businesses, including hundreds of thousands of medical practices, 26 million sole proprietorships, and 2 million farms.

We forget this $600 detail is particularly tough on independent doctor-owned solo or small practices, which may earn as little as $120,000 per year with average educational debts of $24,000 a year, which doesn’t leave much after household, resident , taxes, and children’s education expenses.

We forget what this $600 provision is intended to raise $17 billion over 10 years to help pay for the cost of the Affordable Care Act. The $17 billion will come, it is said, from closing of tax loopholes, but will require millions more to help the IRS enforce compliance.

We forget that the Senate next week will vote for repeal of the $600 provision because of waves of protest from the business community which supplies most of the nation’s jobs.

We forget the White House is very nervous about repeal of this $600 reporting provision, which is attached as an amendment to the $50 billion bill to help small business.

The Obama administration fears that repeal could set a precedent for rolling back other unpopular features of the law.

They also fear repeal may block passage of Obama’s symbolic small business bill, designed to aid small business by cutting taxes and rewarding investment.

It is unclear whether Democrats and Republicans can reach agreements on repealing the provision and on finding a way to offset the loss of money.

We forget that unforgettable massive amounts of money and forgettable massive documents foster forgetfulness of devilish details.

Details! Details! So many details! Forget them at your own risk.

Please don’t forget the health reform details, They may drive the Obama political train off the rails. They may cost you as an individual aplenty. Few of you will know in precise dollars how many, until you weigh the details on our own scales.


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