Obamacare: What Will You Do?

Damned if you do, damned if you don’t.

Definition of Calvinism, Doctrine of Predestination

February 14, 2013 -  Happy Valentine’s Day, all you sweethearts out there.  But this is not about sweetheart deals.  It’s about what you will do under Obamacare.

It depends on who you are and what you do in the next few years, which are crucial to whether Obamacare succeeds or fails. 

·         If you are a non-Medicaid, non-Medicare consumer, not much.  About 55% of you get your health insurance through your employer, and 32% under government program.  Your costs will rise as your employer and government  passes along costs.  And if you are among the 18 million Americans in your 20s and 30s, you will be pressured to buy insurance, and  you may become IRS prey.

·         If you are employer, you will likely wait and see. Or you will offer your employees   health savings accounts, and let them shop for care.  Or if you are approaching 50 employees or have more than that,  you may resist being mandated to offer expensive benefits to those working 30 hours or more.  You may reduce  your employees to part-time work of 29 hours or less.   Or,  if the CBO projections  are on target,  you  may drop 8 million workers from coverage altogether.

·         If you are the governor of a state, you will have to decide whether to set up a health exchange or let the federal government do it. If you’re a governor of  a liberal state, like New York or California, you will set up a health exchange.   If you’re in Texas or Georgia or Florida, you may not. The betting odds are Medicaid rolls will grow from 36 million to 45 million and Medicare may expand  to 55 million to 60 million from the current 47 million. But federal money is hard to resist, and those who don’t will continue to  sit on the fence. 

·         If you are health-care provider,  like  hospitals,  physicians, or  10% of other Americans who work in the health care sector,  you will resist. For Obamacare rests on the dubious proposition you can “save” the government money by cutting government funds for providers by 40% over next ten years,  just as demand for health care is peaking.  So, to protect yourself , you merge and grow bigger, and you make yourself indispensable by forming budget-proof and bullet-proof  monopolies that can raise prices. This works particularly  well for hospitals acquiring physicians’ practices.  If a hospital system,  integrated or not, dominates a region,  where else are health plans or government going to go to provide care for their constituents.  

Tweet:  Consumers, employers, state governors, and health caregivers will simply have to wait and see what you  will have to do under Obamacare.