An "uncertainty" virus has shadowed the Patient Protection and Affordable Care Act since its inception and passage in 2010. Another layer of uncertainty arrived with the announcement last week that the Obama administration is going to delay the provision that employers with 51 or more full-time employees must offer insurance or pay a penalty.
Employers - many of whom are in the business of making money and expanding, which creates jobs and improves our sluggish economy - may be somewhat relieved that this notion is going back into the garage for service for a year, but it is another certain dot on the uncertain ACA landscape that plagues the business sector.
Does anybody really think retooling the employer mandate during an election year is going to meet with grand success and be rolled out to adoring health care crowds in 2015?
We don't think so. We think we are in for a wild ride between now and implementation phases of ACA on Jan. 1, 2014, 2015 and 2016. We hope we are wrong, but we are going to strap on our life jackets, helmets and seat belts.
What else is going to happen that will cause the people who create jobs - and we don't mean government jobs - to stop dead in their tracks and decide that not hiring is less risky than hiring in this climate?
Right out of the chute, the Obama administration talked about how a larger pool of insured would raise the tides and provide better, cheaper health care for all. The paint on such pronouncements wasn't even dry before waivers were issued to some businesses because the Affordable Care Act was not going to pencil out for them in the near or long term. They got to opt out for some periods of time while other businesses were going to have to play or pay.
Until last week.
This begs some big questions: Can the federal government be trusted to do all the things it says it is going to do regarding the ACA? Does anybody involved really understand the dozens of intersections of causes and effects that this mammoth program will exact on our economy and future?
Idaho and its health care providers are tolerating the system, performing due diligence because they really are interested in providing better and more affordable care to Idahoans. At this juncture, it is tempting to wonder if what many feared all along - that the ACA will eventually collapse under its own weight.
The Obama administration was hoping that young healthy, uninsured people would run over each other in their zeal to sign up for health care. Not so much. The modest "penalty" for not doing so is hardly an incentive - if they even knew of or cared about a mandate. When it comes to businesses, a similar scenario developed. Rep. Mike Simpson, R-Idaho, reported Congressional Budget Office findings recently suggesting that "employers are discovering that they would rather pay a $2,000 fine to the government instead of subsidizing their employee plans, which would cost them about $10,000 for a family policy. If this trend continues, the overall cost of the bill will swell exponentially when it is implemented."
While the Idaho Health Insurance Exchange continues to ramp up and prepare to begin doing business in 84 days on Oct. 1, we have to wonder what other adjustments could come down the ACA pike.
The carrot of infusing federal dollars to states that expand Medicaid programs appears to come with a three-year guarantee. Idaho has resisted that carrot to date. State leaders are criticized for not welcoming all that federal money which could, in fact, improve the health care of the state's poor.
Some interpret the ACA twists and turns as resiliency on a shakedown cruise. But before we go all in, we believe we need to see if more uncertain seas are on the horizon.
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