Wednesday, November 7, 2012

ObamaCare is here to stay

With the re-election of Barack Obama and Democrats retaining control of the Senate, the debate over the future of ObamaCare is over: it is the law, will remain the law, and will be fully implemented in 2014. To the extent that there is still a question about its future, it is whether the states will agree to expanding Medicaid to all of the poor and near poor and to set up marketplaces to buy subsidized private insurance. Every state that says no to either or both will take away from the law's promise of taking of covering nearly all Americans. And the fact remains that the public remains deeply divided about the law. Still . . . there is a chance, a hope, a promise, a potential, that the country can move past the polarized, ideological debate over repealing ObamaCare on one hand (won't happen) to making it better (could happen). The election doesn't settle which choice the country will make, except that it will not be repealed. But I hope that when realization sets in among the public that ObamaCare won't be repeated, there will be a renewed willingness to take what is good about the law, especially coverage of the uninsured, and make changes where needed (how about real medical liability reform as a start?) to make it better Today's question: What do you think the election mean for ObamaCare?


Steve Lucas said...

I have a different view of Obamacare and the changes it will bring to American medicine. The IRS has ruled that anyone working 30 hours or more per week will be considered full time. This will result in more part time employment. All of you parents with children living at home or who will graduate college in the next four years with a boat load of student debt should expect your children to work part time.

All of the taxes will kick in including a tax on the gross sales of devices. This will impact the cost of everything from knee replacements to heart valves. There will be a tax increase on everyone’s 401k as taxes on dividends go up, so along with higher cost for medical devices our retiree’s will have less disposable income.

EMR’s will continue to drain money from medical treatment with the promise of patient information available as a way to contain cost becomes an even more distant dream:

Insurance companies are now purchasing medical practices in what I feel is an attempt to control cost. This will better allow them to access government programs and set treatment standards as they will now represent an ever growing number of physicians.

The growing number of physicians leaving private practice and opting for employment will only increase in the next four years as government increases demands for paperwork and oversight. The only practices to escape will be cash, retainer, or direct pay.

Yep, Obamacare will move full steam ahead and all those wishing to see a doctor will still find themselves closed out since reimbursement will not be high enough under existing government programs to be financially viable for the medical practice to survive.

Be careful what you wish for, there can be a big difference between what we want, medical care for all, and what we get.

Steve Lucas

Arvind said...

The public will get what they deserve. Long live the King.

Congrats Bob. You won. But patients and doctors lost yesterday.

ryanjo said...

Repeal never was the likely fate of Obamacare. It is much too good a whipping horse for the opposition. Healthcare, the economy, immigration reform all are the new battlegrounds for at least the next two years. This election decided nothing except the occupant of the White House. The issues and methods are the same. Our country is headed off a cliff in 55 days as the mandatory cuts begin, sparing nothing, including Bob's favorite piece of legislation.

Are these the right people to be redesigning healthcare? Why does our medical leadership think that those who recently disgusted us with hyperbole & attack ads can pull this off?

ryanjo said...

I just received an email from my healthcare insurer, titled "Health Care Reform: What Could It Cost You in 2013?" To quote:
>>Many Americans could face higher tax bills on Jan. 1, 2013, as a result of four health care-reform law changes and with the re-election of President Obama.
1. Limit on flexible spending account (FSA) contributions. Today, employers set their own caps on how much employees can contribute to these plans that let them use pretax money to pay for health care expenses. For 2013, the government will enforce a $2,500 limit per employee.
2. A new Medicare surtax on investment income. Until now, Medicare taxes have only applied to earned income. For 2013, taxpayers filing individually with wages and self-employment income above $200,000 ($250,000 for married couples filing jointly) will pay a 3.8% surtax.
3. An additional Medicare tax on wages and self-employment income for some. The existing Medicare payroll tax of 2.9% (of which 1.45% is paid by a taxpayer through payroll deductions) will be increased by 0.9% on wages or self-employment income that exceeds $200,000 for single and qualifying head of household and widow(er) filers ($250,000 for married couples filing jointly).
4. Higher hurdle for deducting medical expenses. Currently, out-of-pocket medical costs only are deductible to the extent they exceed 7.5% of your adjusted gross income. For 2013, that hurdle will rise to 10%. But if you’re 65 or older, that threshold remains frozen at 7.5% through 2016.<<

Sum it up: More taxes on the now less than 50% of Americans that pay taxes, primarily on high earners, professionals and business owners who might be able to expand and provide more America-based jobs. Target the medical profession by both higher taxes and also lowering deductible health savings (less patients willing to pay for health care).

I guess ACP leadership missed this when they threw their support to Obamacare. No good deed goes unpunished.

Harrison said...

Ryanjo -- Yes there are taxes but will they have any impact on the vast majority of your patients?
Marginal rate increases that start at $200,000 of earned income or that impact only investment income on people who earn more than $200,000 will not impact any of my patients that I know of.
And the notion that it will impact the job market has been debunked by non-partisan studies.
Increasing marginal tax rates does not effect the choices of wealthy people when it comes to creating jobs.
Jimmy Carter in four years created 10.3 million jobs with a top tax rate of 70%.
Bill Clinton's top tax rate resulted in far greater job growth than the lowered top tax rate of George W Bush.

Many things effect job growth and the economy, but marginal tax rate increases of 3 or 4% are not among them.
And arguably they could help if they shrink the US debt load and improve the credit markets in the US.


John said...

Keep watching the papers. Multiple reports today about corporations planning to "game the ACA" by reducing hours on employees to 30 hrs or less, which effectively waivers them out of complying with ACA provisons and taxes. Unanticipated consequences of yet another ill-considered government program, and falling most heavily on the very workers who need the income and benefits most.

The tax impact in my post above referred to negative effects on investors and others who create new jobs in good times. I think you need to rework your figures on the taxation and economic results. For example, Jimmy Carter's presidency was an era of hyperinflation (13.5%), not growth.