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Tuesday, July 02, 2013

An Ode To Three-Dimensional Chess

The employer mandate for ACA (Obamacare) is going to be suspended until 2015. 

Here, here, here.  What's being said about the basis for this decision is clearly nonsense. Not only that, but it makes nonsense of the individual mandate and the subsidy provisions on the exchange, because the subsidy provisions depend on whether you are offered "affordable" coverage by the employer.

What's really going on is that, as I have maintained, ACA can never really go into effect because we literally can't afford it.

What's probably forcing this announcement (this is the leak - not the official announcement, which is no doubt scheduled for 4:30 PM on Friday of July Fourth weekend, when all the reporters are already drunk) is the problem of Medicaid/Medicare reimbursement rates for low-paid health care workers. These reimbursement levels are set by the government, but they do not allow enough money to pay for insurance, or pay the fines for not having insurance. 

So we have a situation in which either these staffing agencies have to go all part-time (extremely difficult), or the government has to pay them more money so they can at least pay the fines. Not doable, and can you imagine what the political upshot would be? But the alternative is unthinkable - what would happen to nursing homes? Would they boot out the Medicare/Medicaid crew? 

And you can't run one of these places on 29 hours a week. The problems are immense - three eight-hour shifts amount to 24 hours already, and the workers are paid so little that they won't even eat on that.

But, as I pointed out, the individual mandate makes no effing sense without the employer mandate (to cover and report), nor do the exchanges. even function. So the joy doesn't stop here.

My wife works for one of the companies that was competing for the contract to set up the Obamacare exchange staffing. Basically, to hire the staff to work the phones, process applications, and verify eligibility, etc. The final contract to set up that function and implement it was awarded *last weekend*

The ACA exchanges are supposed to be going live in October. That is a little over 3 months to roll out a trained workforce to sign up the millions of people looking for insurance in the exchanges.

Good luck with that!
THis is the link to the contract award from CMS:

Forbes takes up the issue...

"But delaying the employer mandate could lead, ultimately, to its repeal, which would do much to transition our insurance market from an employer-sponsored one to an individually-purchased one."


The employer mandate is dead. Big business will win. They always do. They do not even want to pay taxes...

"In 2010, large, profitable corporations paid an effective tax rate of 12.6 percent of their global income, the General Accountability Office found. That compares with a top statutory rate -- or the rate paid before deductions and other tax breaks -- of 35 percent. Counting state, local and foreign taxes, U.S. multinationals paid an effective rate of roughly 17 percent."


Even I pay a higher tax rate.

Treasury projects $1,234,012 trillion dollars in tax receipts this fiscal year from individuals. Corporations? $287,716 Billion.

Corporate profits 2012: $1.75 trillion

It's the young millennial generation who will bare the burden along with their student debt. They voted Obama into office. They will soon learn that elections have consequences.
Jill - one wonders if the law even can be implemented. After more than two years, it seems that we are no further.

I don't know why so much of this was left to the last minute. Did everyone think the SC was going to strike?

Anon - I hear ya. They haven't even written the regs for all of this yet, which makes the task of trying to have the exchanges open in October impossible.

Thanks for the contract link. Today's news just moves the bar even further up. It's a contract that can't be met. The information from the IRS and employers was supposed to be used to handle a lot of the cost-figuring. Now?

This is soooo ridiculous.
And frankly, Jill, just to let off some steam -

I don't think they should have done this. I don't think it's legal. We've heard how wonderful this thing is, so at least try to make it work.

Well, there are articles out there quoting some unnamed Treasury source as saying that the individual penalties will have to be delayed until after the election too, but that isn't the point, is it? Do we really want to try to delay this for four years? The law was passed in 2010.

We passed a law with a really long implementation timeline. If we are ever going to even try to implement it, now is the time. If not, then we need to go back and try to deal with the problem again, legislatively.

People still don't have health insurance. It's still a huge problem for individuals and businesses. This is a problem that STILL needs to be addressed.

Plus, we are already getting all the bad stuff. Millions of employees are having their hours cut. This does nothing to mitigate that.

The problem with the home health and nursing home caretakers is very real, but then we need to take it up in law. And if the regulators can just airily defer this for an entire year, then they could issue a smaller regulatory exemption for those people, and let most of it go on.
You don't suppose this has any thing at all, not a smidgen, to do with the
2014 congressional elections??? Just
imagine the fallout with hours cut,
workers dumped on the struggling exchanges by companies making the logical connection that $2k fine is
less than $5k or 10K of insurance coverage. Couldn't be political, not
a chance.
First Anon again,

Seeing how the administration has publically stated how everything was going to be ready this year. This reverse course in rhetoric seems to indicate that the decision makers in the WH are finally figuring out that Obamacare implementation is going to be a clusterfuck of epic proportions.

I imagine that for the last 2 years, bureaucrats and consultants at very lowest levels have been looking at implementing the law, doing a facepalm, and then telling their boss its not going to happen. The boss then whips into action and says "No, we can make this work, by doing X,Y,and Z."

Months later the boss finally realizes his underlings were right, and then he tells his bosses. Those bosses of course say, "No, we can make this work, by doing A, B, and C."

We've probably been through a half-dozen iterations of this in the bureaucracy. I'm guessing that what we are seeing now is Obama's version of Q, R, and S, which will likely make matters even worse.
I thought the employer and individual mandates dates were hard coded in the legislation. If that is true and they were not at "the discretion of the Secretary", then the administration cannot unilaterally delay the requirement.

We have an administration that does not believe it is ever bound by law if that is inconvenient.
I wonder if Justice Roberts has an opinion on this. After all, Obamcare is now his creation, as much as it is Obama's.

Maybe he could advise Obama as to the ideal implementation date.
Just another step along the road to no payer.
Rick - it is not legal, but I think because this is a provision of tax law that only members of Congress may have the ability to sue?

Anyone else can try, but I suspect they will be ruled to have no standing.

And would it be to Congress' advantage to sue? Electorally? Wouldn't any member of Congress be highly exposed in the election?

Perhaps Gowdy may.

Since this cuts off one of the main funding sources of the legislation, it is no minor matter.
First Anon - I think this comes from the highest level.

Not even writing regs for the required business reporting until now is one indication that the jig has been up for a while.

Admittedly the whole exchange concept has been an administrative nightmare from the get-go, but this appears to be a willful step.

If you were a state that tried to do the exchange on its own, I imagine that right now you'd be feeling pretty betrayed.

No matter how far you have gone on a wrong road, turn back.
There was never, of course, any reason to believe that Obama was any good at *ordinary* chess, let alone the three-dimensional chess that the media asserted he was so brilliant at.

But, more importantly, there's this observation from George Eliot:

"Fancy what a game of chess would be if all the chessman had passions and intellects, more or less small and cunning; if you were not only uncertain about your adversary's men, but a little uncertain also about your own . . . You would be especially likely to be beaten if you depneded arrogantly on your mathematical imagination, and regarded your passionate pieces with contempt. Yet this imaginary chess is easy compared with a game man has to play against his fellow-men with other fellow-men for instruments."

This point seems utterly beyond Obama's grasp.

A flashback via the archives of the editorial pages of the New York Post, April 22, 2012:

All quotes:
"… [A]as part of its hundreds of billions in Medicare cuts, the Obama one-size-fits-all plan slashes reimbursement rates for Medicare Advantage starting next year — herding many seniors back into the government-run program.

Under federal “open-enrollment” guidelines, seniors must pick their Medicare coverage program for next year by the end of this year — which means they should be finding out before Election Day…[O]pen enrollment begins Oct. 15, less than three weeks before voters go to the polls.

It’s hard to imagine a bigger electoral disaster for a president than seniors in crucial states like Florida, Pennsylvania and Ohio discovering that he’s taken away their beloved Medicare Advantage just weeks before an election…

But the administration’s devised a way to postpone the pain one more year, getting Obama past his last election; it plans to spend $8 billion to temporarily restore Medicare Advantage funds so that seniors in key markets don’t lose their trusted insurance program in the middle of Obama’s re-election bid."

The employer mandate is dead. Big business will win. They always do.

Employer-based health insurance is a stupid idea in the first place. The only reason it exists is because of FDR's illegal wage freezes. To keep good employees the employers of the time had to find a creative way to give those employees something extra that wasn't counted as income.

I would LOVE to purchase my own health insurance but only if my employer would pay me for the benefit I would no longer take. Trying to get an HR staff to agree to such a thing would be so stressful it would put me in the hospital.
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