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Shots - Health Blog
Tue July 3, 2012
True Or False? Elected Officials Interpret The Health Law
How well do you remember what's actually in the Affordable Care Act?
Last week's Supreme Court decision upholding President Obama's signature domestic achievement has thrust the measure back into the spotlight, where it's likely to remain through the presidential election.
But judging from the comments on this week's Sunday talk shows, it seems some of Washington's elected officials still aren't so clear on exactly how the law does — and doesn't work.
So here's a little true-false test.
Here's House Democratic Leader Nancy Pelosi describing what the law provides for consumers when she appeared on NBC's Meet the Press:
"Pelosi: If you're a person who has a child with diabetes, no longer will they be discriminated against because of a preexisting condition. If you're a woman, no longer will you have to pay more; no longer will being a woman be a pre-existing medical condition. If you're a senior, you pay less for your prescription drugs and nothing for a preventative check - wellness checkups."
Is this true or false?
If you said true, give yourself an apple. These are mostly benefits that have already taken effect, other than not charging women more because of their gender. That one doesn't start until the year 2014.
Next, here's a comment from Louisiana Republican Gov. Bobby Jindal, who also appeared on Meet the Press.
"Jindal: Every governor's got two critical decisions to make. One is do we set up these exchanges. And, secondly, do we expand Medicaid. And no, in Louisiana, we're not doing either one of those things. I don't think it makes sense to do those. I think it makes more sense to do everything we can to elect Mitt Romney to repeal Obamacare."
This one is a little bit trickier. In fact, it's also true — although it wasn't before last week's Supreme Court decision.
Let's take them one at a time. Health exchanges are the online marketplaces where individuals and small businesses will go to shop for health insurance — and, for many individuals, get subsidies from the federal government. States can set up their own exchange, or, if they choose not to, the federal government will run one for them.
Medicaid is a little different. The law calls for a major expansion of the joint health program for people with low incomes — adding everyone with income under about 15 thousand dollars a year to the rolls. Until last week, that WAS in effect a requirement for states. But the court ruled it has to be optional. With the federal government picking up the vast majority of the cost, though, most states are expected to take the money. So far about a half dozen Republican governors, including Jindal, say they won't.
Now here's an exchange between House Speaker John Boehner, and CBS's Norah O'Donnell on Face the Nation:
"Boehner: It's clear that Obamacare is increasing the cost of health insurance for all Americans and making it virtually impossible for small employers to hire new workers.
O'Donnell: How does it make it hard for small employers to hire more workers?
Boehner: Because they're being required to either provide health insurance or pay a fine. Well, I'm sorry, a tax. It's now a tax since the court said it was a tax."
Actually, not so much.
The court did say the penalty some people will pay for not having insurance starting in 2014 is a tax. That's what Chief Justice John Roberts said makes it constitutionally permissible.
But small employers aren't actually subject to that requirement. That's why it's called the INDIVIDUAL mandate. Most small employers — those with fewer than 50 workers — don't have to do anything under the law, and could actually save money by being able to purchase insurance through the new health exchanges. Really small employers; those with fewer than 25 workers, don't have to do anything but if they do offer insurance they're eligible for a tax credit.
And once more on the tax question, again, from Gov. Jindal and Meet the Press host David Gregory, about what happened in Massachusetts, which imposed a similar insurance requirement in 2006:
"Gregory: In Massachusetts there were very few people who actually had to pay. Most people got health insurance. That's a fact, isn't it?
Jindal: That's the whole point. This is not about collecting revenue. It's about changing behavior. So, for example, the first lady is --
Gregory: So you say it's a big new tax increase. Very few people actually had to pay a tax
Jindal: It's the threat of a new tax increase to change behavior."
Now we're getting somewhere. For Republicans, it's not about how many people might pay the tax. It's the concept of using the tax code to force people to do things they might otherwise prefer not to.
And by the way, the Urban Institute estimates that only about 7 million Americans will even be subject to the possibility of having to purchase insurance or pay the fine, tax, or whatever you want to call it.
Expect to hear a lot more of this in the coming weeks and months.