Should The Employer Mandate Survive?

Over the period January 8th through the 11th of last week the Morning Consult conducted a poll of 1,707 registered voters to understand their views regarding the Employer Mandate. The reported responses have a margin of error of +/- 2.4% (I assume that’s at 95% CI). What they found seems a bit counterintuitive at first. But it may reflect an indication of where we sit along the curve to better understanding the economics of healthcare in the United States.

Of those polled, 74% believe that a 40-hour workweek should constitute full-time employment – not 30, the definition used as part of the Affordable Care Act’s employer mandate provision. But only 58% support Congress’s effort to legislatively change that definition. Why? Dunno. And yet, 57% of respondents overall support the employer mandate provision of the Act, and 55% believe companies should provide healthcare for part-time employees.

Whether employers are required to provide health insurance for their workers at 20, 30 or 50 hours misses the broader discussion of whether the employer mandate still makes sense in light of other provisions of the Act having been enacted. And it misses the political discussion of whether it’s a reasonable and plausible giveback to a Republican Congress that’s carried around the repeal and replace bone long enough.

Even the most ardent opponents of the ACA have to admit, if they are being honest, the past few years have increased the individual and social consciousness of healthcare as a very real – and very expensive – commodity that has been more misunderstood than any other product or service in history. And despite the major early challenges of the insurance exchanges most indications now support the dawning of a new dynamic in financing healthcare delivery: the expansion of individual insurance and responsibility.

Ever since wage freezing during WW II led employers to use healthcare benefits in seeking competitive advantage recruiting workers the disconnect between what individuals pay out of pocket for healthcare – and what healthcare actually costs to produce – has been an underlying source of tremendous waste and inefficiency. Have the exchanges, coupled with the incremental increase in Medicaid expansion, made the employer mandate concept moot – or worse, an economic albatross that could stifle growth at a time when the country just might be turning a corner?

What do you think?

Cheers,
  ~ Sparky

 

You’re No Prince, Mr. President

Last week the Administration announced that the Employer Mandate would be again further delayed – at least in part. Businesses with between 50 and 99 employees working 30 hours or more will not be required to make available mandated healthcare coverage until 2016. While businesses with 100 or more employees working at least 30 hours only need offer coverage to 70% of their employees in 2015, rather than 95% (which will not be mandated until 2016).

“Well, isn’t that conveeeeeeeenient . . .”

A little too thinks Senator Mike Lee (R-Utah). On this morning’s Fox News Sunday with Chris Wallace, Lee said that he believes the President is creating a “government of one” by further delaying the mandate – and in his view, ignoring the Constitution in the process.

Sidebar: how much longer do you think Mr. Wallace will be able to withstand Fox’s propaganda machine?

E.g., watch embarrassing exchange between
Chris Wallace and Tucker Carlson.

The premise of Mr. Lee’s position was that the president’s choice to delay the employer mandate was, “a shameless power grab that’s designed to help the president and his particular party achieve a particular outcome in an election. And that’s wrong.”

I think Mr. Lee is right.

Rep. Xavier Becerra (D-Calif.) defended the initiative on Fox News Sunday by claiming, “the president is simply providing small businesses with the flexibility they need.”

Sorry Mr. Becerra, that rings hollow and you should have been embarrassed to even pretend to believe that had anything to do with the delay. I obviously can’t speak for other supporters, but from my vantage Mr. Obama’s renegade approach to policy making has gone too far.

I have been  a pretty ardent supporter of the Affordable Care Act, and I continue to believe that, on balance, it will ultimately bring about necessary and desperately needed changes in the way our healthcare delivery system is designed. I also continue to believe that our failure to address the cost trajectory of our delivery system would have ultimately resulted in fiscal choking from within and ultimately destroy our economy. Finally, because of the unique characteristics of healthcare as an economic commodity – as well as the regulatory infrastructure that has already been in place for decades – I do not believe it is either wise nor prudent to think that a market-based system of healthcare can be successfully compatible with a progressive society. Most of the rest of the developed countries in the world agree.

Those beliefs notwithstanding, the wisdom of Nancy Pelosi grows daily: it’s not just that the ACA had to be passed to find out what’s in it – it’s that clearly the promulgation of regulations implementing the ACA under executive authority has at times supplanted the function of legislative authority. Regardless of how frustrating and demoralizing this Congress has been, there are reasons why certain powers are reserved to the legislative branch and certain powers are reserved for the executive branch.

But the timing of this latest action – whether a tipping point or accumulative – is not only a supplanting of legislative authority but also crosses an ethical line between governing and politics, which of course in Washington requires quite a journey to traverse.  In using what I will term, Obamavellian Authority, the president has repeatedly overstepped executive authority and dared to tread over boundaries that presidents of both parties from the past respected (well okay, maybe not Nixon).

It’s time the president’s supporters call him to account in the interest of democracy and respect for a way of life that transcends political allegiances. Hope you agree, but if not, I would love to hear from you.

Cheers,
  Sparky

Mandate Delay: Chuckhole or Sinkhole?

AARepublicans have failed to thwart it. The Supreme Court refused to kill it. A majority of Americans decided not to abandon it through a national referendum election. And it would appear Nancy Pelosi has still not taken the time to find out what’s in it.

Earlier today when asked whether there could be, “any virtue” in last week’s announcement that businesses with 50 or more full-time employees will not have to begin complying with ACA reporting requirements until 2015 (a year delay), she responded, “no – absolutely not.  I don’t think it’s virtuous at all.  In fact, the point is, is that the mandate was not delayed.  Certain reporting by businesses that could be perceived as onerous — that reporting requirement was delayed, partially to review how it would work and how it could be better. It was not a delay of the mandate for the businesses, and there shouldn’t be a delay of the mandate for individuals.”

Mind you now businesses are being exempted from the codified penalty associated with failing to report how many full-time employees they have, the number of hours they work and how much those individuals have to pay for company-sponsored health insurance coverage. While employers are, “encouraged” to provide affordable insurance for their workers in 2014 there will be no penalty if they do not. That’s not a delay? Who is her policy advisor anyway? Dennis Kucinich?

Aside from the side show of political haberdashery that is by no means the singular purview of Ms. Pelosi nor the Democratic party there are some potentially critical ramifications of the Administration’s decision to delay implementation. On the one hand, because a majority of businesses with 50 or more employees already offer healthcare benefits (e.g., 94% of businesses with 50-199 workers offer coverage while only 1% of US workers are employed by companies with 50 or more employees that do not offer health benefits) the delay’s impact on coverage expansion is not going to be significant.

On the other hand, the delay is nothing less than a giftwrapped political grenade in the hands of the GOP and every interest group in opposition to any element of the ACA. Now called into question will be the workability of not only the employer mandate but other elements of the Act, such as the all-important Individual Mandate, Insurance Exchanges, Medicaid expansion and on and on. If critics are right that the ACA is a bureaucratic house of cards built on a shaky table, well then this delay could be viewed as removing the matchbook from under the table’s leg.

There is also the pragmatic side of this discussion that argues it is better to delay and use that time wisely to ensure implementation is as effective and economical as possible. But it would seem to me the implementation of the IM will be more complicated than the EM because of numbers and nature: there are a lot more individuals than businesses, and by their very nature many (most?) of those individuals don’t have the inherent technical wherewithal to collect and provide the information that will be required for the IM. Delaying implementation of the Individual Mandate would, I believe, be a death knell for the ACA, and I think most Democrats (and, of course, Republicans) share that view now.

It may be a monumental task for many Democrats next summer having one foot on the campaign trail and one finger in the Capital Hill dike that is holding back a full repeal of the Affordable Care Act. If they are not already in place, the Administration had better abandon all hope of allowing partisanship to influence resource decisions. Not getting the right people in the right place to withstand the oncoming attempts to sacrificially slaughter the IM and exchanges before they even get started will be a political nightmare for the Democratic party that may take several decades to overcome.

Cheers,
  Sparky

Artower

Artower

Policy Prescriptions

Advocates for Evidence-Based Health Policy™

Health Affairs BlogHealth Affairs Blog

When 280 characters is just not enough

ChangingAging

with Dr. Bill Thomas