Friday, January 2, 2015

“Challenges” Facing ObamaCare in 2015

An unhatched egg is to me the greatest challenge in life.

E.B. White (1899- 1985), American essayist

Look at it this way. The upcoming June decision by the Supreme Court on the King v. Burwell case, namely, whether it is legal for Obamacare to subsidize persons on the 37 federal exchanges, is an unhatched egg.

If the health law chick survives coming out of the hatch, Obamacare lives. If the chick dies emerging during the hatch, the health law may die aborning, and the chicken will have come to roost with all of its associated disruptions.

In the words of Greg Sargent in today’s Washington Post (“A SCOTUS Decision Gutting ObamaCare Could Cause Widespread Disruptions”).
“One of the big, looming questions of 2015 is this: Will the Supreme Court really gut Obamacare subsidies in the three dozen states on the federal exchange, potentially depriving millions of health coverage at a moment when the law, now heading into its second year, is clearly working as intended?”
Or look at it this way, the Supreme Court is just one of 4 other chicks about to hatch( “ObamaCare 2015 Challenges ,” Sarah Ferris, The Hill, January 1, 2015).

If you really want to know what’s the future holds for ObamaCare, get thee to the Washington hatchery, where young legislative bills are hatched , cared for, sold, or die.

For political commentators, “challenge” is a useful word. In the medical world, challenge has come to mean exposing a person to a substance to see if evokes an allergic or adverse reaction. In the political word, “challenge” means one of two things: one, to invite someone to participate in a fight, competition, or contest; two, to test one’s ability to engage in a political battle, or rise to the occasion.

In 2015, political challenges arise from these 4 events, which are about to see the full light of day for the first time.

One, the employer mandate goes into effect for businesses with over 100 employees. This was delayed the first time around for businesses with over 50 employees. But now against business and GOP opposition, it will out in the open, and subject to challenge.

Two, fines to be levied by the IRS for the first time for the individual mandate for not having a health plan or for not giving accurate information about your true income status. The penalties will be stiff: on average, $498.50 for a single person with an income of $60,000; $1369.50 for head of a household with 2 children and an income of $150,000; and $2297 for a couple with a joint return , 2 children, and an income of $250.000 (source: the IRS), and the Kaiser Foundation).

Three, primary care doctors face Medicare cuts. Medicare raises for primary care doctors ran out the last week of 2014. Now doctors will face average Medicare cuts of 43% and over 50% in states like California and New York. If the past is any indication, doctors will react by seeing fewer Medicare patients.

Four, doctors receiving Medicare patients will be fined for not using e-records. The government has spent over $30 billion getting doctors to adapt e-records. But now the time has come in which doctors will be docked 3% to 11% of their Medicare income for not using these records to document Medicare patient data or to prescribe. Since installing an e-record system costs the typical 5 person practice $165,000, many doctors will resist and may leave the federal system by engaging in alternative direct pay care or by becoming hospital employees and working fewer hours .

Whatever happens, we are about to find out whether long incubated and newly hatched legislative chicks can survive in the heat of the political oven. This is complicated by the reality that many doctors will chose to get out of the oven.

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