JCHS IPE 300

The inability of the American middle class to get ahead is only in part due to the excessive growth of healthcare costs. Who paid that $125 billion dollar care cost? Taxpayers. Not only will all taxpayers soak up the costs, but they will also be paying for the premiums on top of that. Is it always fair to heavily tax the wealthy just because they are wealthy? Where is the justification? The wealthy will not remain wealthy or placid if we constantly depend on them to support the rest of us. We all need to contribute with more of an equal percentage.

Argument against Small business

1. You will be penalized $750 per full-time employee if you’re a company with 50 or more employees, and you don’t provide health insurance. The government won’t charge you for the first 30 workers you don’t cover.

2. You face additional fines if you don’t cover 60% of overall employee health costs, as well government-defined set of services.

3. If you offer your employees health insurance you must cover no less than 72.5% of the cheapest health plan you offer for individuals, and no less than 65% for families. You must automatically enroll every employee in a health plan with the lowest employee premium, unless they opt out.

4. If you choose not to provide health coverage you must pay the Health Choices Commissioner (the person in charge of the SHOP exchange fund) 8% of the average wages paid during a predefined period of enrollment. They charge you a lower percentage if your annual payroll is less than $400,000.

5. You don’t cover your employees and don’t pay your SHOP fee. You’re fined $100 per violation day.

6. Small businesses will only qualify for a full tax credit when they employee 10 or less employees with annual salaries less than $25,000 annually, and the employer must pay for at least 50% of the employees premiums. The amount of the tax credit will only cover approximately 35% of the employers total premium. This leaves the employer responsible for 65% of the cost for paying one half of the employees premium.

7. The increased expenses that the employer will pay out to cover their employees to participate in the exchanges will probably cost more than what the individual employee could obtain if they purchased their insurance themselves on the exchange.

8. The employers actual cost for the premiums over covering their employees will only be 8 to 11% cheaper than if they had purchased them without receiving a tax credit.

9. Small businesses are only eligible to receive the tax credit between the years of 2010 and 2013 and then for any two additional years after that. After the 6 years of coverage, small businesses will be on their own.

10. While the tax credit is available to businesses that employee up to 25 employees with salaries up to $50,000 per year, the amount of the tax credit is substantially less.

Reference:

DREA. (2010, March 24). What health care reform means for small business. Retrieved from http://www.businesspundit.com/what-health-care-reform-means-for-small- business/

Miller, E. (2011). Affordability of Health Insurance to Small Business: Implications of the Patient Protection and Affordable Care Act. Journal Of Health Politics, Policy & Law, 36(3), 539-546. doi:10.1215/03616878-1271225

Under point number 2, less quality of care would result from doctors spending even less time per appointment. The usual time is around 15 minutes; any less time than this will barely get past the initial assessment. The longer wait times are those times in between appointments and tests or elective surgeries. Patients in other countries with a public health system have waited months for necessary CT's x-rays.etc. Physician fatigue will result in an increase in medical errors, malpractice suits, decreased patient and doctor satisfaction, and increased mortality rates.

1. More than 87 million Americans could lose access to their current health care plan under the new law

2. Fewer physicians would be available which would result in a less quality of care, longer wait times, and physician fatigue.

3. It would become a socialistic form of healthcare.

4. Patients may face a penalty for not having health insurance. Is my constitutional right violated? Congress would set a precedent for

using the commerce clause in the constitution which states that Congress has the power to regulate commerce...among the several

states.

5. The Center for Medicare and Medicaid Services says that the law will impose billions of dollars in annual fees on drug companies,

health insurance plans, and new taxes on medical device sales. This alone will raise health care costs from 2.1 billion dollars to

18.2 billion dollars in 2018.

6. The biggest item used to pay for the program is more than 500 billion dollars in cuts to the Medicare program. This is not good

timing for the 72 million baby boomers who will need this assistance.

7. Out of pocket will be a burden on the middle class-24 million are without insurance, the max out of pocket limit for a family will be

11,900 on top of premiums; in 2009, 1.5 million Americans declared bankruptcy-of these 62% were medically related-and of these,

1/4 had insurance.

8. As a patient, I may not be treated as a human being in need not only of my medical necesssities, but with care, worth, dignity,and

understanding. This will be due to the fact that I will be viewed as a financial asset or burden according to my diagnosis and health.

Reference Health Care Laws/Obamacare retreived from Pro/Con org.9/26/12

This was an error in posting. Please disregard this argument

As Insurance Executives we are definitely against reform. One of the keys that many miss in the reform plan is that insurance companies are facing a risk base capital change and are now required to keep more capital in reserve to cover claims; this is significantly larger than it has been in the past. By continuing to raise the risk based capital, insurance companies have less capital to cover operational costs or maintain operations and have to look at alternative sources to either increase revenue or decrease operational cost. Layered with the other requirements of the Affordable Care Act, this could be the beginning of the end for the commercial insurance industry, as we know it. The trickledown effect will be devastating. Insurance carriers will look for alternatives, either raising costs or decreasing operational costs; companies will be faced with unhappy clients, who will either leave or go without coverage regardless of the penalty, and the downward spin will begin.

Congress was challenged at the Supreme Court level on portions of the Health Care Act, but not all areas were addressed. It is fraught with issues. Although the intentions behind the Act were meant to be good, it does not appear that anyone looked at the true financial implications of the Act. Public health care will definitely come to us quickly, with this act destroying the foundations and the competitive edge of the insurance industry in a free enterprise. Regulation is one thing but to be setup for failure is truly unconscionable.

As it stands now, insurance providers are able to select who receives coverage and which ones are turned down (those who need coverage the most, the sick and elderly). Private insurers currently cover a less costly population, those who are employed and tend to be young and healthy. The United States government has passed the Affordable Care Act, a system of insurance mandate. Insurance is to be made available to and be carried by individuals and all businesses. One recommendation to the reform is to create state or regional insurance exchanges to pool risk, so that all Americans could obtain a standard benefits package. Where would the spirit of free enterprise go? Can Congress legally and justifiably mandate insurance? Capitalism would turn to socialism. As an executive of an insurance company, the government should not be passing laws that are going to risk the company's very existence.

Yes, perhaps the thought was, it would control greed within the industry. However, that greed will continue unless business ethics are addressed within the industry and strict standards are put into place. This one act is setting an unprecedented action.

As Insurance Executives, the Affordable Care Act is going to be detrimental to private insurance companies and will significantly reduce the profitability of the sector. Private insurance is being forced to provide coverage for more people, some with significant pre-existing conditions, without being able to significantly increase premium rates or deny coverage based on the specific pre-existing needs. For these reasons, many small companies will go out of business, placing increased burdens on the private companies that are able to remain operational. Those remaining will have to follow guidelines, similar the ones established for Medicare and Medicaid, to ensure that some level of profitability remains.

Some of the specific standards that are most going to effect the private insurance industry are: accounting for expenditures of premiums received, inability to impose annual or lifetime limits on individual benefits, and the requirement of essential benefits plans. Under the Affordable Care Act, private insurance companies are going to be required to show that 80-85% of collected premiums are spent on medical services for the subscribers, leaving only 15-20% of monies collected to cover administrative and other overhead costs of operation. This problem is further compounded by the fact that it is no longer acceptable to impose annual or lifetime limits on the amount of coverage that the private insurance company must pay to cover “essential” healthcare services. For this reason, chronically ill individuals that are non-compliant with dietary, medication, or other wellness plans and that are admitted to the hospital on a frequent basis due to exacerbation of their disease process may cost the insurance company more than what it is receiving in premiums form the individual.

One benefit that the Affordable Care Act may provide private insurance companies lies within the standards that are being placed on facilities receiving payments from Medicare and Medicaid. By adopting similar standards, it may be possible for private insurance companies to recoup some of the profits, which would otherwise be lost due to new laws surrounding revoking coverage on individuals. Included in the Medicare reimbursement plan is reduced payments for hospital readmits that are deemed preventable, and a loss of payment for hospital acquired infections which increase the overall cost of caring for the patient. Utilizing these two methods of reimbursement and bundling payments for each hospital stay should help to contain costs to a moderate degree and hopefully ensure some profitability.

Also, the reform’s push to have everyone utilizing electronic health records is a plus. To date, the standards in the industry for electronic health records and the sharing of data to care adequately for patients and control costs have been poor. There is much work to be done in this area, but this is one small positive of the reform act is meaningful. It will resolve all of the industry needs, but it will push healthcare to adopt computerization and move forward in ways we have never seen before. It is, also, responsible for creating jobs in the economy that previously may not have been necessary.

References:

Arrow, K. & Ven,V. (2009). Toward a 21st Century Health Care System: Recommendations for Health Care Reform. Annals of Internal Medicine, 150(7).

Hall, M.A. (2011). Clearing out the underbrush in constitutional challenges to healthcare reform. New England Journal of Medicine, 364(9), 1-4.

The Staff of the Washington Post. (n.d.). Landmark: The Inside Story of America’s New Health-Care Law and What it Means for Us All (pp. 153-164). Thorndike Press.

The united states insurance financial solvency framework. (2010). Retrieved from http://www.naic.org/documents/committees_e_us_solvency_framework.pdf